Coronary Microcirculation in Aortic Stenosis: Pathophysiology, Invasive Assessment, and Future Directions

Figure 1

Animal aortic banding model that parallels the development of aortic valvular stenosis: at baseline, the systolic demand (shaded) and diastolic supply (not shaded) are well balanced when recording the aortic and left atrial pressures in this animal model of dynamic, supravalvular stenosis. With progressive banding demand rises (shaded area increases), supply falls (due to acute tachycardia in this animal model but also rising left atrial filling pressures marked as filled areas during diastole). Coronary blood flow (CBF, which corresponds to mean coronary blood flow) begins as diastolic dominant (unique to the normal heart) but concludes as systolic dominant (more typical of a peripheral organ bed) (reprinted from Figure 2 of a 1972 publication [12]).