After TAVI, positive FFR values worsened from 0.71 to 0.66, while negative FFR values improved slightly from 0.92 to 0.93; changes in treatment indication were infrequent.
Does transcatheter aortic valve implantation alter the fractional flow reserve of concomitant coronary artery disease in patients with severe aortic valve stenosis?
TAVI has a minor overall effect on the FFR of concomitant coronary lesions, but may cause borderline lesions to become functionally significant, changing treatment indications in a small percentage of cases.
Absolute Event Rate: 0% vs 0%
Background— Aortic valve stenosis may influence fractional flow reserve (FFR) of concomitant coronary artery disease by causing hypertrophy and reducing the vasodilatory reserve of the coronary circulation. We sought to investigate whether FFR values might change after valve replacement. Methods and Results— The functional relevance of 133 coronary lesions was assessed by FFR in 54 patients with severe aortic valve stenosis before and after transcatheter aortic valve implantation (TAVI) during the same procedure. A linear mixed model was used to verify the interaction of TAVI effect with the FFR values. No significant overall change in FFR values was found before and after the aortic valve stenosis removal (0.89±0.10 versus 0.89±0.13; P =0.73). A different trend in FFR groups (positive if ≤0.8; negative if >0.8) was found after TAVI ( P for interaction 50 worsened after TAVI (0.84±0.12 versus 0.82±0.16; P =0.02), whereas FFR values in arteries with mild lesions (percent diameter stenosis <50) tended toward improvement after TAVI (0.90±0.07 versus 0.91±0.09; P =0.69). Functional FFR variations after TAVI changed the indication to treat the coronary stenosis in 8 of 133 (6%) lesions. Conclusions— Coronary hemodynamics are influenced by aortic valve stenosis removal. Nevertheless, FFR variations after TAVI are minor and crossed the diagnostic cutoff of 0.8 in a small number of patients after valve replacement. Borderline coronary lesions might become functionally significant after valve replacement, although FFR-guided interventions were infrequent even in patients with angiographically significant lesions.
Pesarini et al. (Tue,) reported a other. After TAVI, positive FFR values worsened from 0.71 to 0.66, while negative FFR values improved slightly from 0.92 to 0.93; changes in treatment indication were infrequent.
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