Coronary Hemodynamics in Patients With Severe Aortic Stenosis and Coronary Artery Disease Undergoing Transcatheter Aortic Valve Replacement: Implications for Clinical Indices of Coronary Stenosis Severity.

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Version: Final published version
License: CC BY 4.0
Serval ID
serval:BIB_6F54594EA08D
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Coronary Hemodynamics in Patients With Severe Aortic Stenosis and Coronary Artery Disease Undergoing Transcatheter Aortic Valve Replacement: Implications for Clinical Indices of Coronary Stenosis Severity.
Journal
JACC. Cardiovascular interventions
Author(s)
Ahmad Y., Götberg M., Cook C., Howard J.P., Malik I., Mikhail G., Frame A., Petraco R., Rajkumar C., Demir O., Iglesias J.F., Bhindi R., Koul S., Hadjiloizou N., Gerber R., Ramrakha P., Ruparelia N., Sutaria N., Kanaganayagam G., Ariff B., Fertleman M., Anderson J., Chukwuemeka A., Francis D., Mayet J., Serruys P., Davies J., Sen S.
ISSN
1876-7605 (Electronic)
ISSN-L
1936-8798
Publication state
Published
Issued date
22/10/2018
Peer-reviewed
Oui
Volume
11
Number
20
Pages
2019-2031
Language
english
Notes
Publication types: Journal Article ; Multicenter Study ; Research Support, Non-U.S. Gov't
Publication Status: ppublish
Abstract
In this study, a systematic analysis was conducted of phasic intracoronary pressure and flow velocity in patients with severe aortic stenosis (AS) and coronary artery disease, undergoing transcatheter aortic valve replacement (TAVR), to determine how AS affects: 1) phasic coronary flow; 2) hyperemic coronary flow; and 3) the most common clinically used indices of coronary stenosis severity, instantaneous wave-free ratio and fractional flow reserve.
A significant proportion of patients with severe aortic stenosis (AS) have concomitant coronary artery disease. The effect of the valve on coronary pressure, flow, and the established invasive clinical indices of stenosis severity have not been studied.
Twenty-eight patients (30 lesions, 50.0% men, mean age 82.1 ± 6.5 years) with severe AS and coronary artery disease were included. Intracoronary pressure and flow assessments were performed at rest and during hyperemia immediately before and after TAVR.
Flow during the wave-free period of diastole did not change post-TAVR (29.78 ± 14.9 cm/s vs. 30.81 ± 19.6 cm/s; p = 0.64). Whole-cycle hyperemic flow increased significantly post-TAVR (33.44 ± 13.4 cm/s pre-TAVR vs. 40.33 ± 17.4 cm/s post-TAVR; p = 0.006); this was secondary to significant increases in systolic hyperemic flow post-TAVR (27.67 ± 12.1 cm/s pre-TAVR vs. 34.15 ± 17.5 cm/s post-TAVR; p = 0.02). Instantaneous wave-free ratio values did not change post-TAVR (0.88 ± 0.09 pre-TAVR vs. 0.88 ± 0.09 post-TAVR; p = 0.73), whereas fractional flow reserve decreased significantly post-TAVR (0.87 ± 0.08 pre-TAVR vs. 0.85 ± 0.09 post-TAVR; p = 0.001).
Systolic and hyperemic coronary flow increased significantly post-TAVR; consequently, hyperemic indices that include systole underestimated coronary stenosis severity in patients with severe AS. Flow during the wave-free period of diastole did not change post-TAVR, suggesting that indices calculated during this period are not vulnerable to the confounding effect of the stenotic aortic valve.
Keywords
Aged, Aged, 80 and over, Aortic Valve Stenosis/complications, Aortic Valve Stenosis/diagnosis, Aortic Valve Stenosis/physiopathology, Aortic Valve Stenosis/surgery, Blood Flow Velocity, Cardiac Catheterization, Coronary Artery Disease/complications, Coronary Artery Disease/diagnosis, Coronary Artery Disease/physiopathology, Coronary Stenosis/complications, Coronary Stenosis/diagnosis, Coronary Stenosis/physiopathology, Female, Fractional Flow Reserve, Myocardial, Hemodynamics, Humans, Hyperemia/physiopathology, London, Male, Predictive Value of Tests, Reproducibility of Results, Severity of Illness Index, Sweden, Transcatheter Aortic Valve Replacement/adverse effects, Treatment Outcome, TAVR, aortic stenosis, coronary flow, fractional flow reserve, instantaneous wave-free ratio
Pubmed
Web of science
Open Access
Yes
Create date
03/09/2018 13:07
Last modification date
16/12/2019 6:19
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