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Gallinoro E, Paolisso P, Bertolone DT, Esposito G, Belmonte M, Leone A, Viscusi MM, Shumkova M, De Colle C, Degrieck I, Casselman F, Penicka M, Collet C, Sonck J, Wyffels E, Bartunek J, De Bruyne B, Vanderheyden M, Barbato E. Absolute coronary flow and microvascular resistance before and after transcatheter aortic valve implantation. EUROINTERVENTION 2024; 20:e1248-e1528. [PMID: 39374094 PMCID: PMC11443252 DOI: 10.4244/eij-d-24-00075] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 07/22/2024] [Indexed: 10/09/2024]
Abstract
BACKGROUND Severe aortic stenosis (AS) is associated with left ventricular (LV) remodelling, likely causing alterations in coronary blood flow and microvascular resistance. AIMS We aimed to evaluate changes in absolute coronary flow and microvascular resistance in patients with AS undergoing transcatheter aortic valve implantation (TAVI). METHODS Consecutive patients with AS undergoing TAVI with non-obstructive coronary artery disease in the left anterior descending artery (LAD) were included. Absolute coronary flow (Q) and microvascular resistance (Rμ) were measured in the LAD using continuous intracoronary thermodilution at rest and during hyperaemia before and after TAVI, and at 6-month follow-up. Total myocardial mass and LAD-specific mass were quantified by echocardiography and cardiac computed tomography. Regional myocardial perfusion (QN) was calculated by dividing absolute flow by the subtended myocardial mass. RESULTS In 51 patients, Q and R were measured at rest and during hyperaemia before and after TAVI; in 20 (39%) patients, measurements were also obtained 6 months after TAVI. No changes occurred in resting and hyperaemic flow and resistance before and after TAVI nor after 6 months. However, at 6-month follow-up, a notable reverse LV remodelling resulted in a significant increase in hyperaemic perfusion (QN,hyper: 0.86 [interquartile range {IQR} 0.691.06] vs 1.20 [IQR 0.99-1.32] mL/min/g; p=0.008; pre-TAVI and follow-up, respectively) but not in resting perfusion (QN,rest: 0.34 [IQR 0.30-0.48] vs 0.47 [IQR 0.36-0.67] mL/min/g; p=0.06). CONCLUSIONS Immediately after TAVI, no changes occurred in absolute coronary flow or coronary flow reserve. Over time, the remodelling of the left ventricle is associated with increased hyperaemic perfusion.
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Affiliation(s)
- Emanuele Gallinoro
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Division of University Cardiology, IRCCS Galeazzi - Sant'Ambrogio Hospital, Milan, Italy
| | - Pasquale Paolisso
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Division of University Cardiology, IRCCS Galeazzi - Sant'Ambrogio Hospital, Milan, Italy
| | | | - Giuseppe Esposito
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Marta Belmonte
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Attilio Leone
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Michele Mattia Viscusi
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | | | | | - Ivan Degrieck
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
| | | | | | - Carlos Collet
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
| | - Jeroen Sonck
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
| | - Eric Wyffels
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
| | | | - Bernard De Bruyne
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | | | - Emanuele Barbato
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
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Scisciola L, Paolisso P, Belmonte M, Gallinoro E, Delrue L, Taktaz F, Fontanella RA, Degrieck I, Pesapane A, Casselman F, Puocci A, Franzese M, Van Praet F, Torella M, Marfella R, De Feo M, Bartunek J, Paolisso G, Barbato E, Barbieri M, Vanderheyden M. Myocardial sodium-glucose cotransporter 2 expression and cardiac remodelling in patients with severe aortic stenosis: The BIO-AS study. Eur J Heart Fail 2024; 26:471-482. [PMID: 38247224 DOI: 10.1002/ejhf.3145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 12/22/2023] [Accepted: 01/08/2024] [Indexed: 01/23/2024] Open
Abstract
AIM Cardiac remodelling plays a major role in the prognosis of patients with aortic stenosis (AS) and could impact the benefits of aortic valve replacement. Our study aimed to evaluate the expression of sodium-glucose cotransporter 2 (SGLT2) gene and protein in patients with severe AS stratified in high gradient (HG) and low flow-low gradient (LF-LG) AS and its association with cardiac functional impairments. METHODS AND RESULTS Gene expression and protein levels of main biomarkers of cardiac fibrosis (galectin-3, sST2, serpin-4, procollagen type I amino-terminal peptide, procollagen type I carboxy-terminal propeptide, collagen, transforming growth factor [TGF]-β), inflammation (growth differentiation factor-15, interleukin-6, nuclear factor-κB [NF-κB]), oxidative stress (superoxide dismutase 1 [SOD1] and 2 [SOD2]), and cardiac metabolism (sodium-hydrogen exchanger, peroxisome proliferator-activated receptor [PPAR]-α, PPAR-γ, glucose transporter 1 [GLUT1] and 4 [GLUT4]) were evaluated in blood samples and heart biopsies of 45 patients with AS. Our study showed SGLT2 gene and protein hyper-expression in patients with LF-LG AS, compared to controls and HG AS (p < 0.05). These differences remained significant even after adjusting for age, gender, body mass index, history of diabetes mellitus, arterial hypertension, and coronary artery disease. SGLT2 gene expression was positively correlated with: (i) TGF-β (r = 0.72, p < 0.001) and collagen (r = 0.73, p < 0.001) as markers of fibrosis; (ii) NF-κB (r = 0.36, p < 0.01) and myocardial interleukin-6 (r = 0.68, p < 0.001) as markers of inflammation: (iii) SOD2 (r = -0.38, p < 0.006) as a marker of oxidative stress; (iv) GLUT4 (r = 0.33, p < 0.02) and PPAR-α (r = 0.36, p < 0.01) as markers of cardiac metabolism. CONCLUSION In patients with LF-LG AS, SGLT2 gene and protein were hyper-expressed in cardiomyocytes and associated with myocardial fibrosis, inflammation, and oxidative stress.
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Affiliation(s)
- Lucia Scisciola
- Department of Advanced Medical and Surgical Science, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Pasquale Paolisso
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
- Department of Advanced Biomedical Sciences, 'Federico II' University, Naples, Italy
| | - Marta Belmonte
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
- Department of Advanced Biomedical Sciences, 'Federico II' University, Naples, Italy
| | - Emanuele Gallinoro
- IRCCS Ospedale Galeazzi Sant'Ambrogio, Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Leen Delrue
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | - Fatemeh Taktaz
- Department of Advanced Medical and Surgical Science, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Rosaria Anna Fontanella
- Department of Advanced Medical and Surgical Science, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Ivan Degrieck
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | - Ada Pesapane
- Department of Advanced Medical and Surgical Science, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | | | - Armando Puocci
- Department of Advanced Medical and Surgical Science, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Martina Franzese
- Department of Advanced Medical and Surgical Science, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | | | - Michele Torella
- Department of Translation Medical Science, University of Campania 'Luigi Vanvitelli' and Monaldi Hospital, Naples, Italy
| | - Raffaele Marfella
- Department of Advanced Medical and Surgical Science, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Marisa De Feo
- Department of Translation Medical Science, University of Campania 'Luigi Vanvitelli' and Monaldi Hospital, Naples, Italy
| | | | - Giuseppe Paolisso
- Department of Advanced Medical and Surgical Science, University of Campania 'Luigi Vanvitelli', Naples, Italy
- UniCamillus, International Medical University, Rome, Italy
| | - Emanuele Barbato
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Michelangela Barbieri
- Department of Advanced Medical and Surgical Science, University of Campania 'Luigi Vanvitelli', Naples, Italy
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