Aortic stenosis and angina with normal coronary arteries: the role of coronary flow abnormalities

摘要

While left ventricular hypertrophy and reduced coronary flow reserve provide a substrate for myocardial ischaemia in aortic stenosis, other more complex factors such as coronary impedance, left ventricular wall stress, and transaortic pressure difference must also play a major role in the aetiology of angina in this condition. The study of phasic coronary artery flow patterns using Doppler echocardiography has improved our understanding of these mechanisms, but more wore work needs to be done before their role in aortic stenosis is fully defined.