PloS one
Coronary microvascular dysfunction in patients undergoing transcatheter aortic valve implantation: A systematic review and meta-analysis
By Panyawongkhanti M, Chintrakulchai P, Tanking C and 1 others.
Abstract
Background
Coronary microvascular dysfunction (CMD) is a complication of severe aortic stenosis. Its prevalence after transcatheter aortic valve implantation (TAVI) and prognostic significance are understudied, as are the post-TAVI trajectories of microvascular indices.
Aims
The aims of this study were to determine the pooled prevalence of CMD, the influence of the diagnostic modality, the post-TAVI coronary flow reserve (CFR) and microvascular resistance changes, and the prognostic impact of baseline CMD on major adverse cardiovascular events (MACE) in patients with severe aortic stenosis undergoing TAVI.
Methods
Five databases were searched from January 2010 to December 2025 for studies involving adults with severe aortic stenosis undergoing TAVI in which CMD was assessed by wire-based thermodilution, angiography-derived indices, Doppler measurements, or stress cardiac magnetic resonance. The risk of bias and certainty of evidence were assessed using the Newcastle-Ottawa Scale and GRADE, respectively. Random-effects meta-analyses (DerSimonian-Laird) pooled CMD prevalence (stratified by modality), CFR change (mean difference; before-after design), and prognostic hazard ratios (HRs). Change in microvascular resistance was synthesized narratively. The protocol was prospectively registered (PROSPERO: CRD42025143775) and reported per the PRISMA 2020 guidance.