Key result
Transcatheter aortic valve implantation significantly decreased fractional flow reserve from 0.85 to 0.71 at 6 months (P<0.001), whereas instantaneous wave-free ratio remained unchanged.
Why the study?
As younger patients are considered for TAVI, the assessment and treatment of concomitant coronary artery disease is taking on increased importance.
Does TAVI alter coronary hemodynamics (FFR and iFR) in patients with severe aortic stenosis and concomitant coronary artery disease?
Observational (n=13)
Does TAVI alter coronary hemodynamics (FFR and iFR) in patients with severe aortic stenosis and concomitant coronary artery disease?
Absolute Event Rate: 0.71% vs 0.85%
p-value: p=<0.001
TAVI improves hyperemic coronary flow, suggesting that resting indices like iFR may be more reliable than FFR for assessing coronary stenosis severity in patients with severe aortic stenosis.
TAVI-associated FFR decline with stable iFR may favor resting indices for CAD assessment; leaves open prospective validation in severe aortic stenosis.
Background As younger patients are being considered for transcatheter aortic valve implantation (TAVI), the assessment and treatment of concomitant coronary artery disease is taking on increased importance. Methods and Results Thirteen contemporary lower‐risk patients with TAVI with severe aortic stenosis (AS) and moderate‐severe coronary lesions were included. Patients underwent assessment of coronary hemodynamics in the presence of severe AS (pre‐ TAVI ), in the absence of severe AS (immediately post‐ TAVI ), and at longer‐term follow‐up (6 months post‐ TAVI ). Fractional flow reserve decreased from 0.85 (0.76–0.88) pre‐ TAVI to 0.79 (0.74–0.83) post‐ TAVI , and then to 0.71 (0.65–0.77) at 6‐month follow‐up ( P <0.001 for all comparisons). Conversely, instantaneous wave‐free ratio was not significantly different: 0.82 (0.80–0.90) pre‐ TAVI , 0.83 (0.77–0.88) post‐ TAVI , and 0.83 (0.73–0.89) at 6 months ( P =0.735). These changes are explained by the underlying coronary flow. Hyperemic whole‐cycle coronary flow (fractional flow reserve flow) increased from 26.36 cm/s (23.82–31.82 cm/s) pre‐ TAVI to 30.78 cm/s (29.70–34.68 cm/s) post‐ TAVI ( P =0.012), to 40.20 cm/s (32.14–50.00 cm/s) at 6‐month follow‐up ( P <0.001 for both comparisons). Resting flow during the wave‐free period of diastole was not significantly different: 25.48 cm/s (21.12–33.65 cm/s) pre‐ TAVI , 24.54 cm/s (20.74–27.88 cm/s) post‐ TAVI , and 25.89 cm/s (22.57–28.96 cm/s) at 6 months ( P =0.500). Conclusions TAVI acutely improves whole‐cycle hyperemic coronary flow, with ongoing sustained improvements at longer‐term follow‐up. This enhanced response to hyperemic stimuli appears to make fractional flow reserve assessment less suitable for patients with severe AS. Conversely, resting diastolic flow is not significantly influenced by the presence of severe AS. Resting indices of coronary stenosis severity, therefore, appear to be more appropriate for this patient population, although large‐scale prospective randomized trials will be required to determine the role of coronary physiology in patients with severe AS.
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Vendrik et al. (2020) conducted an observational in Concomitant coronary artery disease and severe aortic stenosis (n=13). Transcatheter aortic valve implantation (TAVI) vs. Pre-TAVI (baseline) was evaluated on Fractional flow reserve (p=<0.001). Transcatheter aortic valve implantation significantly decreased fractional flow reserve from 0.85 to 0.71 at 6 months (P<0.001), whereas instantaneous wave-free ratio remained unchanged.
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