Key result
This rationale and design paper outlines a prospective study of 100 patients to evaluate changes in fractional flow reserve 6 months after aortic valve replacement for severe aortic stenosis.
Why the study?
Hemodynamic assessment of CAD severity in patients undergoing valve replacement for severe AS is challenging, as myocardial hypertrophic remodeling may influence FFR and nonhyperemic pressure ratios.
Does aortic valve replacement alter fractional flow reserve and microvascular function in patients with severe aortic stenosis and intermediate coronary artery disease?
Observational (n=100)
Does aortic valve replacement alter fractional flow reserve and microvascular function in patients with severe aortic stenosis and intermediate coronary artery disease?
This study design outlines a prospective evaluation of how aortic valve replacement impacts intracoronary hemodynamics and microvascular function in patients with severe aortic stenosis and concomitant coronary artery disease.
Although concomitant coronary artery disease (CAD) is frequent in patients with severe aortic stenosis (AS), hemodynamic assessment of CAD severity in patients undergoing valve replacement for severe AS is challenging. Myocardial hypertrophic remodeling interferes with coronary blood flow and may influence the values of fractional flow reserve (FFR) and nonhyperemic pressure ratios (NHPRs). The aim of the current study is to investigate the effect of the AS and its treatment on current indices used for evaluation of CAD. We will compare intracoronary hemodynamics before, immediately after, and 6 mo after aortic valve replacement (AVR) when it is expected that microvascular function has improved. Furthermore, we will compare FFR and resting full-cycle ratio (RFR) with myocardial perfusion single-photon emission-computed tomography (SPECT) as indicators of myocardial ischemia in patients with AS and CAD. One-hundred consecutive patients with AS and intermediate CAD will be prospectively included. Patients will undergo pre-AVR SPECT and intracoronary hemodynamic assessment at baseline, immediately after valve replacement [if transcatheter AVR (TAVR) is chosen], and 6 mo after AVR. The primary end point is the change in FFR 6 mo after AVR. Secondary end points include the acute change of FFR after TAVR, the diagnostic accuracy of FFR versus RFR compared with SPECT for the assessment of ischemia, changes in microvascular function as assessed by the index of microcirculatory resistance (IMR), and the effect of these changes on FFR. The present study will evaluate intracoronary hemodynamic parameters before, immediately after, and 6 mo after AVR in patients with AS and intermediate coronary stenosis. The understanding of the impact of AVR on the assessment of FFR, NHPR, and microvascular function may help guide the need for revascularization in patients with AS and CAD planned for AVR.
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Minten et al. (2021) conducted an observational in Aortic valve stenosis and intermediate coronary artery disease (n=100). Aortic valve replacement (AVR) vs. Baseline (pre-AVR) was evaluated on Change in fractional flow reserve (FFR) 6 months after AVR. This rationale and design paper outlines a prospective study of 100 patients to evaluate changes in fractional flow reserve 6 months after aortic valve replacement for severe aortic stenosis.
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