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Transcatheter aortic valve implantation is investigated as a potential driver of reversal. Patients with aortic stenosis and coronary disease undergo multimodality assessment before TAVI and at 6 months, combining coronary angiography, microvascular indices, cardiac magnetic resonance, and computational modeling of absolute coronary flow and microvascular resistance. Findings show increased coronary flow reserve alongside reduced resting coronary flow and myocardial blood flow, while microvascular resistance remains unchanged.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/changes-in-myocardial-blood-flow-and-microvascular-resistance-in-patients-with-coronary-artery-disease-undergoing-transcatheter-aortic-valve-implantation/439265/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/changes-in-myocardial-blood-flow-and-microvascular-resistance-in-patients-with-coronary-artery-disease-undergoing-transcatheter-aortic-valve-implantation/439265.png","ImageObject",300,407,{"name":92,"@type":93},"Sophia Brooks","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-06","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",17,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"What patient population and intervention were studied?","Question",{"text":113,"@type":114},"Patients with severe aortic stenosis and concomitant coronary artery disease undergoing transcatheter aortic valve implantation were evaluated before the procedure and again 6 months later.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"Which imaging and physiological methods were used to assess coronary function?",{"text":118,"@type":114},"Coronary angiography and thermodilution-derived microvascular indices were combined with stress perfusion cardiac magnetic resonance to measure global myocardial blood flow and left ventricular mass, supported by computational modeling of vessel-specific absolute coronary flow and microvascular resistance.",{"name":120,"@type":111,"acceptedAnswer":121},"What were the main changes after TAVI in coronary physiology?",{"text":122,"@type":114},"Coronary flow reserve increased, driven largely by reductions in resting absolute coronary blood flow and both resting and stress myocardial blood flow on cardiac magnetic resonance. Microvascular resistance and IMR remained unchanged.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},439265,1790718914,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":44,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":145,"preview_page_count":4},962084925636,"https://ap-avatar.wpscdn.com/davatar_994ba38a5ba835b3df7d355c54d3ed8d","Open access Interventional cardiology  \n Changes in myocardial blood flow and  \nmicrovascular resistance in patients with coronary artery disease undergoing transcatheter aortic valve implantation  \nEron Yones,1,2 Rebecca Gosling,1,2 Daniel Taylor  ,1,2,3  \nTom Alexander Howard Newman  ,1,2 Mark Sammut,1,2 Saadia Aslam,2 Javaid Iqbal,1,2 Muhammad Aetesam-ur-Rahman,2 Kenneth Morgan,2 Amir Aziz,2 Melanie Neville,2 Ever Grech,2 Paul D Morris,1,2 Julian Gunn1,2  \n► Additional supplemental material is published online only. To view, please visit the journal online ([https://doi.org/10.1136/](https://doi.org/10.1136/)[ ](https://doi.org/10.1136/)[openhrt-2025-003621](openhrt-2025-003621)) .  \nTo cite: Yones E, Gosling R, Taylor D, et al. Changes in myocardial blood flow and microvascular resistance inpatients with coronary artery disease undergoing transcatheter aortic valve implantation. Open Heart 2025;12:e003621 . doi:10 . 1136/ openhrt-2025-003621  \nReceived 31 July 2025  \nAccepted 23 November 2025  \n© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY.  \nPublished by BMJ Group.  \n1School of Clinical Medicine and Population Health, The University of Sheffield, Sheffield, UK 2Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK  \n3The University of Sheffield, Sheffield, UK  \nCorrespondence to  \nDr Eron Yones; eron.yones2@ [nhs.net](nhs.net)  \nABSTRACT  \nBackground Severe aortic stenosis (AS) causes apathophysiological cascade, which impairs myocardial blood flow. This effect is exacerbated in the presence of coronary disease (CAD) . Treatment with transcatheter aortic valve implantation (TAVI) may promote reversal of these pathophysiological conditions.  \nMethods We performed multimodality assessment of cardiac physiology in patients with AS and concurrent CAD requiring percutaneous coronary intervention, prior to and 6 months after undergoing TAVI. Techniques include: coronary angiography and bolus thermodilution-derived indices of microvascular function (coronary flow reserve (CFR); index of microcirculatory resistance (IMR)); stress perfusion cardiac magnetic resonance (CMR) imaging, which was used to measure changes in global myocardial blood flow (MBF) and left ventricular mass (LVM), and computed resting and hyperaemic vessel specific absolute coronary flow (aCBF) and microvascular resistance (MVR) using a computational model of coronary physiology. Results Data were obtained for seven patients (10 vessels) . CFR increased from 1.53 (1 .2–1.7) to 2.35 (2 .0–2.7) (p=0 .037) 6 months post-TAVI. There was a 33% reduction in resting aCBF from 218 mL/min to 146 mL/min (p=0 .004) . On CMR, resting MBF fell 37% from 3.0±0.98 mL/min/g to 1.9±0.7 mL/min/g (p=0.033) and stress MBF fell 25% from 3 .6±0 .57 mL/min/g to 2.7±0 .7 mL/min/g (p=0 .004) . Indexed LVM regressed from 79±14 g/m2 to 71±16 g/m2 (p=0 .006) . MVR remained unchanged.  \nConclusions CFR increased following TAVI. The mechanism for this was a significant reduction in resting coronary blood flow measured with CMR and modelled computationally. The unchanged MVR and IMR suggest that resting blood flow reduces due to reduced myocardial demand and myocardial remodelling, rather than changes in resistance.  \nINTRODUCTION  \nUntreated severe aortic stenosis (AS) causes an unrelenting pathophysiological cascade which, over time, impairs myocardial blood  \nWHAT IS ALREADY KNOWN ON THIS TOPIC  \n\n| ⇒ Patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI) frequently have concomitant coronary artery disease (CAD) . The effect of TAVI on coronary physiology, including microvascular resistance and absolute myocardial blood flow, is relatively unknown.\u003Cbr>WHAT THIS STUDY ADDS |\n| --- |\n| ⇒ This study quantified changes in global and vesselspecific coronary physiology prior to and 6 months after TAVI in patients with AS and concomitant CAD requiring percutaneous coronary intervention. There was a significant increa","cbCaieQbgTq9HFZ2","https://ap.wps.com/l/cbCaieQbgTq9HFZ2","pdf",834574,"English","# Abstract\n# Background\n# Methods\n# Results\n# Conclusions\n# Introduction\n# What is already known on this topic\n# What this study adds\n# How this study might affect research, practice or policy","[{\"question\":\"What patient population and intervention were studied?\",\"answer\":\"Patients with severe aortic stenosis and concomitant coronary artery disease undergoing transcatheter aortic valve implantation were evaluated before the procedure and again 6 months later.\"},{\"question\":\"Which imaging and physiological methods were used to assess coronary function?\",\"answer\":\"Coronary angiography and thermodilution-derived microvascular indices were combined with stress perfusion cardiac magnetic resonance to measure global myocardial blood flow and left ventricular mass, supported by computational modeling of vessel-specific absolute coronary flow and microvascular resistance.\"},{\"question\":\"What were the main changes after TAVI in coronary physiology?\",\"answer\":\"Coronary flow reserve increased, driven largely by reductions in resting absolute coronary blood flow and both resting and stress myocardial blood flow on cardiac magnetic resonance. Microvascular resistance and IMR remained unchanged.\"}]","Changes in myocardial blood flow and microvascular resistance in patients with coronary artery disease undergoing transcatheter aortic valve implantation | PDF",1790688009,23]