Systolic Coronary Flow Reversal and Abnormal Diastolic Flow Patterns in Patients With Aortic Stenosis: Assessment With an

Decreased left ventricular coronary flow reserve has been reported in patients with normal coronary arteries and left ventricular hypertrophy in association with aortic stenosis. However, phasic coronary flow characteristics have not been analyzed in detail in similar patients. The purpose of this study is to assess phasic coronary flow characteristics and their relation to hemodynamic parameters in patients with aortic stenosis. Coronary flow velocities were recorded in the left anterior descending artery with a 20 MHz Doppler catheter in nine patients with aortic stenosis and nine control subjects with normal coronary arteries. Patient aortic valve area ranged from 0.34 to 0.51 cm 2 • Flow reversal was observed in systole in all patients with aortic stenosis, and time velocity integrals of systolic flow were significantly smaller in patients with aortic stenosis than in controls (- 0.3 ± 2.3 vs 4.0 ± 1.1 em, p < 0.01). The time to peak diastolic velocity corrected by v'll-R interval was prolonged and the velocity half-time from peak diastolic velocity corrected by v'll-R interval was shorter in patients with aortic stenosis than in controls (5.3 ± 1.1 vs 4.0 ± 0.5, p < 0.01, 8.0 ± 2.6 vs 13.0 ± 3.3, p < 0.01, respectively). Peak velocity and time velocity integral of flow reversal showed significant correlations with mean pressure gradient across the aortic valve (y = -l.3x + 37.3, r = 0.72,p = 0.03,y = ll.3x + 41.2, r = 0.81,p < 0.01, respectively). These abnormal coronary flow patterns were no longer present after aortic valve replacement in six of nine patients with aortic stenosis who were studied again within 1 month after surgery. In summary, flow reversal in systole and slow acceleration and rapid deceleration of coronary flow velocity in diastole are characteristic in patients with aortic stenosis. These abnormal flow velocity patterns may be related to the pressure difference across the aortic valve. ( J AM Soc ECHOCARDIOGR 1993;516-24.) In patients with aortic stenosis, retrograde coro­ nary artery flow in systole has been reported angiographically 1 and has been confirmed by epicar­ dial Doppler studies during open heart surgery. 2 Its clinical significance is not completely clear, although it is thought to be limiting with respect to myocardial blood supply. This may be particularly disadvanta­ geous in patients with aortic stenosis because angina pectoris in these patients, in the absence of coronary artery disease, has been explained by the imbalance