14
IRUS Total
Downloads
  Altmetric

Coronary haemodynamics in patients with severe aortic stenosis and coronary artery disease undergoing Transcatheter Aortic Valve Replacement: implications for clinical indices of coronary stenosis severity

File Description SizeFormat 
j.jcin.2018.07.019.full.pdfPublished version2.06 MBAdobe PDFView/Open
Title: Coronary haemodynamics in patients with severe aortic stenosis and coronary artery disease undergoing Transcatheter Aortic Valve Replacement: implications for clinical indices of coronary stenosis severity
Authors: Ahmad, Y
Gotberg, M
Cook, C
Howard, J
Malik, I
Mikhail, G
Frame, A
Petraco, R
Rajkumar, C
Demir, O
Iglesias, JF
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
Item Type: Journal Article
Abstract: Objectives 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. Background 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. Methods 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. Results 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). Conclusions 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.
Issue Date: 22-Oct-2018
Date of Acceptance: 17-Jul-2018
URI: http://hdl.handle.net/10044/1/62837
DOI: https://dx.doi.org/10.1016/j.jcin.2018.07.019
ISSN: 1936-8798
Publisher: Elsevier
Start Page: 2019
End Page: 2031
Journal / Book Title: JACC: Cardiovascular Interventions
Volume: 11
Issue: 20
Copyright Statement: © 2018 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation . This is an Open Access Article under the CC BY License (http://creativecommons.org/licenses/by/4.0/)
Sponsor/Funder: The Academy of Medical Sciences
Medical Research Council (MRC)
Wellcome Trust
National Institute for Health Research
Funder's Grant Number: na
MR/M018369/1
PS3162_WHCP
RDB02
Keywords: Science & Technology
Life Sciences & Biomedicine
Cardiac & Cardiovascular Systems
Cardiovascular System & Cardiology
aortic stenosis
coronary flow
fractional flow reserve
instantaneous wave-free ratio
TAVR
FRACTIONAL FLOW RESERVE
WAVE-FREE RATIO
MYOCARDIAL-ISCHEMIA
RESISTANCE INDEX
LESION SEVERITY
INTERVENTION
ADENOSINE
PRESSURE
IMPLANTATION
ANGIOGRAPHY
1102 Cardiovascular Medicine And Haematology
Cardiovascular System & Hematology
Publication Status: Published
Online Publication Date: 2018-08-25
Appears in Collections:National Heart and Lung Institute