Coronary flow in Aortic Stenosis: Pathophysiological and Clinical Insights

[Pages:23]Coronary flow in Aortic Stenosis: Pathophysiological and Clinical Insights

Paolo G Camici MD FESC FACC FAHA FRCP Vita-Salute University and San Raffaele Scientific Institute Milan

Mechanisms of myocardial ischaemia

Epicardial coronary arteries

Atherosclerotic disease

Vasospastic disease

Coronary microcirculation

Microvascular dysfunction

Stable plaque Vulnerable plaque

Reduction In CFR

Focal/transient Plaque rupture vasospasm

Thrombosis

Demand ischaemia ? angina

Acute coronary syndromes/infarction

Prinzmetal angina

Persistent vasospasm

Myocardial infarction

Impairs coronary physiology and myoc. blood flow

in subjects with risk factors

Contributes to myoc. Isch.

in stable athero. disease

Induces severe acute isch. "takotsubo"

Mechanisms of myocardial ischaemia

Epicardial coronary arteries

Atherosclerotic disease

Vasospastic disease

Coronary microcirculation

Microvascular dysfunction

Stable plaque Vulnerable plaque

Reduction In CFR

Plaque rupture

Focal/transient vasospasm

Thrombosis

Demand ischaemia ? angina

Acute coronary syndromes/infarction

Prinzmetal angina

Persistent vasospasm

Myocardial infarction

Impairs coronary physiology and myoc. blood flow

in subjects with risk factors

Contributes to myoc. Isch.

in stable athero. disease

Induces severe acute isch. "takotsubo"

These three mechanisms can overlap

The emerging concept of coronary "microvascular disease"

The tip of the iceberg - Resolution >500?m

Resolution ................
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