CORONARY MICROVASCULAR DYSFUNCTION IN A PATIENT WITH AORTIC STENOSIS DIAGNOSED BY MULTIMODAL IMAGING

Document Type

Conference Proceeding

Publication Date

3-7-2023

Publication Title

J Am Coll Cardiol

Abstract

Background Coronary microvascular dysfunction may contribute to the clinical symptoms in patients with aortic stenosis. Case 80 year old male with past medical history significant for moderate aortic stenosis, hyperlipidemia, obesity, and 60 pack year tobacco use presented with complaints of chest pain and shortness of breath on exertion. His symptoms typically started while shoveling snow, and described as a substernal pressure. He had no prior diagnosed history of coronary artery disease, myocardial infarction, heart failure, or cardiac arrhythmias. Decision-making In the setting of his stable angina, cardiac positron emission tomography (PET) imaging was obtained to further investigate the patients symptoms. Imaging revealed no perfusion evidence of ischemia or infarction with regadenoson pharmacologic stress. PET flow analysis revealed normal resting flow in all coronary territories. There was mild reduction in peak stress flows in the left circumflex, right coronary, and left anterior descending distribution. Regional flow reserves were abnormal in all territories and global flow reserve was less than 2. Overall findings indicated likely combination of diffuse epicardial atherosclerosis along with microvascular dysfunction. As the patient continued to remain symptomatic despite medical therapy, decision was made to perform coronary angiogram. Angiogram revealed diffuse non-obstructive coronary artery disease, however patient was noted to have severe aortic valve stenosis with aortic valve area of 0.99 cm2, with peak to peak gradient of 46mmhg. He was referred for TAVR, with eventual complete resolution of his symptoms. Conclusion Microcirculatory dysfunction in patients with aortic stenosis may explain angina symptoms in absence of obstructive coronary artery stenosis. The use of Cardiac PET imaging is a non-invasive imaging tool that can aid in establishing the diagnosis of coronary microvascular disease.

Volume

81

Issue

8

First Page

3647

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