Feasibility and Comparison of Resting Full-Cycle Ratio and Computed Tomography Fractional Flow Reserve in Patients with Severe Aortic Valve Stenosis

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Severe aortic valve stenosis with intermediate coronary stenosis (n=41). Intervention: Computed tomography derived Fractional Flow Reserve (CT-FFR) vs. Resting Full-cycle Ratio (RFR). Primary outcome: Diagnostic accuracy of CT-FFR for predicting RFR ≤ 0.89 on a per-lesion basis (Accuracy 82.6%, 95% CI 68.6-92.2).

Q: What does this research mean for the field?

Computed tomography-derived fractional flow reserve (CT-FFR) demonstrates high diagnostic accuracy and significant correlation with resting full-cycle ratio (RFR) for assessing intermediate coronary lesions in patients with severe aortic stenosis. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

Hendrik Wienemann; Marcel C. Langenbach; Victor Mauri; Maryam Banazadeh; Konstantin Klein; Christopher Hohmann; Samuel Lee; Isabel Breidert; Alexander Hof; Kaveh Eghbalzadeh; Elmar Kuhn; Marcel Halbach; David Maintz; Stephan Baldus; Alexander C. Bunck; Matti Adam

doi:10.3390/jcdd9040116

April 14, 2022Journal of Cardiovascular Development and DiseaseOpen Access

Feasibility and Comparison of Resting Full-Cycle Ratio and Computed Tomography Fractional Flow Reserve in Patients with Severe Aortic Valve Stenosis

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Why the study?

The study was designed to evaluate the diagnostic performance of CT-FFR compared to the hyperemia-free index RFR in patients with relevant aortic stenosis and intermediate coronary stenosis.

Does CT-FFR accurately predict invasive RFR for assessing intermediate coronary lesions in patients with severe aortic stenosis undergoing routine pre-TAVR CT?

Study Design

Type

Observational (n=41)

Blinding

Single-blind

Multicenter

No

Structured PICO

Does CT-FFR accurately predict invasive RFR for assessing intermediate coronary lesions in patients with severe aortic stenosis undergoing routine pre-TAVR CT?

P

Population

41 patients (mean age 80.9 years, 46% female) with severe aortic valve stenosis and intermediate coronary lesions undergoing pre-TAVR assessment.

E

Exposure

Computed tomography derived Fractional Flow Reserve (CT-FFR) analysis performed using on-site prototype software (Siemens Healthineers) based on routine pre-TAVR CT scans.

C

Comparator

Invasive physiological lesion assessment using Resting Full-cycle Ratio (RFR) via pressure wire during invasive coronary angiography.

O

Outcome

Diagnostic performance (accuracy, sensitivity, specificity, positive predictive value, negative predictive value, and area under the curve) of CT-FFR to predict hemodynamically significant stenosis defined as RFR ≤ 0.89.surrogate

Main Result

Effect estimate: Accuracy 82.6% (95% CI 68.6-92.2)

Limitations

Retrospective observational design from a single center with a limited number of patients, raising the possibility of selection bias.
Included only vessels with physiological assessment at the operator's discretion, excluding severely stenosed or non-stenosed vessels.
High-pitch CT-scan without a specific cCTA-scan may have limited the diagnostic value.
Agreement between CT-FFR and FFR or RFR after TAVR was not evaluated.
Retrospective design
Single center with a limited number of patients (selection bias)
Included only vessels with physiological assessment at the operator's discretion (excluded severely stenosed >80% or non-stenosed vessels)
High-pitch CT-scan without a specific cCTA-scan may have limited diagnostic value
Agreement between CT-FFR and RFR after TAVR was not evaluated

Implication

CT-FFR derived from routine pre-TAVR CT scans is feasible and demonstrates high diagnostic accuracy compared to invasive RFR for assessing intermediate coronary lesions in patients with severe aortic stenosis.

Abstract

Background: Computed tomography derived Fractional Flow Reserve (CT-FFR) has been shown to decrease the referral rate for invasive coronary angiography (ICA). The purpose of the study was to evaluate the diagnostic performance of CT-FFR compared to hyperemia-free index Resting Full-cycle Ratio (RFR) in patients with relevant aortic stenosis (AS) and intermediate coronary stenosis. Methods: 41 patients with 46 coronary lesions underwent ICA with quantitative coronary angiography (QCA), pressure wire assessment and routine pre-transcatheter aortic valve replacement (TAVR) computed tomography (CT). CT-FFR analysis was performed using prototype on-site software. Results: RFR showed a significant correlation with CT-FFR (Pearson’s correlation, r = 0.632, p < 0.001). On a per-lesion basis, diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of CT-FFR were 82.6% (95% CI 68.6−92.2), 69.6% (95% CI 47.1−86.8), 95.7% (95% CI 78.1−99.9), 94.1% (95% CI 69.8−99.1), and 75.9% (95% CI 62.7−85.4), respectively. The optimal cutoff value of the CT-FFR for RFR ≤ 0.89 prediction was 0.815. The area under the receiver curve showed a larger area under the curve for CT-FFR (0.87; 95% CI 0.75−0.98) compared with CTA stenosis of ≥50% (0.54, 95% CI 0.38−0.71), CTA ≥ 70% (0.72, 95% CI 0.57−0.87) and QCA ≥ 50% (0.67, 95% CI 0.52−0.83). Conclusions: CT-FFR assessed by routine pre-TAVR CT is safe and feasible and shows a significant correlation with RFR in patients with AS. CT-FFR is superior to QCA ≥ 50%, CT ≥ 50% and CT ≥ 70% in assessing the hemodynamic relevance of intermediate coronary lesions. Thus, CT-FFR has the potential to guide revascularization in patients with AS.

Discussion

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Cite This Study

Wienemann et al. (2022) conducted an observational in Severe aortic valve stenosis with intermediate coronary stenosis (n=41). Computed tomography derived Fractional Flow Reserve (CT-FFR) vs. Resting Full-cycle Ratio (RFR) was evaluated on Diagnostic accuracy of CT-FFR for predicting RFR ≤ 0.89 on a per-lesion basis (Accuracy 82.6%, 95% CI 68.6-92.2).

synapsesocial.com/papers/6a18d943c9d74cf65281fb19 https://doi.org/10.3390/jcdd9040116

Topics

Coronary CT angiography

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Feasibility and Comparison of Resting Full-Cycle Ratio and Computed Tomography Fractional Flow Reserve in Patients with Severe Aortic Valve Stenosis

Figures

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Topics

Feasibility and Comparison of Resting Full-Cycle Ratio and Computed Tomography Fractional Flow Reserve in Patients with Severe Aortic Valve Stenosis

Figures

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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