Diagnostic Accuracy of Pre-Transcatheter Aortic Valve Replacement Nitroglycerin-Free Fractional Flow Reserve-Computed Tomography-Based Physiological Assessment in Patients With Severe Aortic Stenosis for Predicting Post-Transcatheter Aortic Valve Replacement Ischemia

Satoru Sasaki; Hiroyuki Kawamori; Takayoshi Toba; Ryo Takeshige; Yusuke Fukuyama; Takashi Hiromasa; Hiroyuki Fujii; Tomoyo Hamana; Yuto Osumi; Seigo Iwane; Tetsuya Yamamoto; Shota Naniwa; Yuki Sakamoto; Koshi Matsuhama; Yuta Fukuishi; Toshiro Shinke; Ken–ichi Hirata; Hiromasa Otake

doi:10.1253/circj.cj-23-0312

October 6, 2023Circulation JournalOpen Access

Diagnostic Accuracy of Pre-Transcatheter Aortic Valve Replacement Nitroglycerin-Free Fractional Flow Reserve-Computed Tomography-Based Physiological Assessment in Patients With Severe Aortic Stenosis for Predicting Post-Transcatheter Aortic Valve Replacement Ischemia

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Why the study?

Pre-TAVR physiological assessment using fractional flow reserve-computed tomography had not been validated in patients with severe AS undergoing TAVR due to theoretical difficulties with nitroglycerin use.

Does pre-TAVR FFRCT without nitroglycerin accurately predict post-TAVR invasive FFR in adult patients with severe aortic stenosis undergoing TAVR?

Structured PICO

Does pre-TAVR FFRCT without nitroglycerin accurately predict post-TAVR invasive FFR in adult patients with severe aortic stenosis undergoing TAVR?

P

Population

21 adult patients (34 vessels) with severe aortic stenosis (AS) and moderate or greater (30-90%) stenotic lesions on cCTA and CAG prior to TAVR, mean age 86±4, 38% male, single-center (Japan).

I

Intervention

Pre-TAVR fractional flow reserve-computed tomography (FFRCT) without nitroglycerin

C

Comparator

Pre-TAVR instantaneous wave-free ratio (iFR) without nitroglycerin, pre-TAVR quantitative coronary angiography percent diameter stenosis (CAG %DS), and pre-TAVR coronary computed tomography angiography percent diameter stenosis (cCTA %DS)

O

Outcome

Diagnostic performance of pre-TAVR FFRCT without nitroglycerin, using post-TAVR invasive FFR as the reference standard for ischemiasurrogate

Pre-TAVR FFRCT without nitroglycerin provides good diagnostic accuracy for predicting the physiological significance of coronary stenoses in patients with severe aortic stenosis undergoing TAVR.

Limitations

single-center study
relatively small sample size
did not include patients with left main trunk (LMT) disease

Implication

Pre-TAVR iFR may aid CAD assessment in severe AS; hypothesis-generating and should not yet change practice pending prospective validation.

Abstract

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Discussion

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Cite This Study

Sasaki et al. (2023) studied this question.

synapsesocial.com/papers/6a6fa2c9b27f158178270a1f https://doi.org/10.1253/circj.cj-23-0312

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Diagnostic Accuracy of Pre-Transcatheter Aortic Valve Replacement Nitroglycerin-Free Fractional Flow Reserve-Computed Tomography-Based Physiological Assessment in Patients With Severe Aortic Stenosis for Predicting Post-Transcatheter Aortic Valve Replacement Ischemia

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

Diagnostic Accuracy of Pre-Transcatheter Aortic Valve Replacement Nitroglycerin-Free Fractional Flow Reserve-Computed Tomography-Based Physiological Assessment in Patients With Severe Aortic Stenosis for Predicting Post-Transcatheter Aortic Valve Replacement Ischemia

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

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