Key result
New trial protocol evaluates acute and long-term coronary physiology changes after TAVI.
Why the study?
Does TAVI alter coronary physiological indices (FFR, CFR, IMR) in patients with severe aortic stenosis and intermediate LAD stenosis?
Does TAVI alter coronary physiological indices (FFR, CFR, IMR) in patients with severe aortic stenosis and intermediate LAD stenosis?
This study design outlines a protocol to assess how relieving aortic valve pressure overload via TAVI affects invasive coronary physiological indices and their correlation with non-invasive myocardial perfusion.
Hypothesis-generating protocol for post-TAVI coronary physiology; leaves open FFR/CFR/IMR changes and SPECT cut-offs in severe AS.
The prevalence of coronary artery disease (CAD) in patients with severe aortic stenosis (AS) is 30-68%. Nevertheless, there is still not enough evidence to use invasive assessment of lesion severity, because the hemodynamic milieu of AS may impact the fractional flow reserve (FFR) and non-hyperemic indices. Therefore, the aim of the study is two-fold. First, to measure acute and long-term changes of FFR, index of microvascular resistance (IMR), and coronary flow reserve (CFR) in patients undergoing TAVI procedure. Second, to compare the diagnostic accuracy of intracoronary indices with myocardial perfusion measured by cadmium-zinc-telluride single-photon emission tomography (CZT-SPECT) and find cut-off values defining significant stenosis. We plan to enroll 40 patients eligible for TAVI with intermediate stenosis (30-70%) in the left anterior descending (LAD) coronary artery. In each patient FFR, CFR, and IMR will be measured in addition to myocardial blood flow calculated by CZT-SPECT before and either immediately after TAVI (acute cohort) or in 6 months (late cohort) after the procedure. FFR, CFR, and IMR will be matched with the results of myocardial perfusion measured by CZT-SPECT in the area of LAD. As a result, cut-off values of FFR, CFR, and IMR defining the decreased blood flow will be found.
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Dobrolińska et al. (2022) studied Severe aortic stenosis with intermediate coronary artery stenosis (n=40). Transcatheter Aortic Valve Implantation (TAVI) vs. Baseline (pre-TAVI) was evaluated on Acute and long-term changes in FFR, IMR, and CFR. This rationale and design paper describes a planned study of 40 patients to evaluate acute and long-term changes in coronary physiology indices following transcatheter aortic valve implantation.
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