Author + information
- Gabriele Pesarini1,
- Roberto Scarsini2,
- Carlo Zivelonghi3,
- Anna Piccoli2,
- Alessia Gambaro4,
- Valeria Ferrero2,
- Corrado Vassanelli5 and
- Flavio Ribichini6
- 1Ospedale Civile Maggiore Borgo Trento, Verona, Italy
- 2Division of Cardiology, University of Verona, Verona, Italy
- 3Azienda ospedaliera universitaria di Verona, Verona, Venice, Italy
- 4Azienda ospedaliera Verona, Verona, Venice, Italy
- 5Division of Cardiology, University of Verona, Verona, Venice, Italy
- 6Università di Verona, Verona, Italy
Aortic valve stenosis (AVS) may influence fractional flow reserve (FFR) of concomitant coronary artery disease (CAD) by causing hypertrophy and reducing the vasodilatory reserve of the coronary circulation. The hypothesis was made that TAVI, changing ventricular function by eliminating valvular obstruction, can improve coronary blood flow and then influence the functional assessment of coronary lesions. We sought to investigate if FFR values might change after valve replacement.
In this prospective, observational study, FFR measurements were attempted in the three major epicardial arteries before TAVI and immediately after the trans-catheter valve implantation maintaining similar hemodynamic conditions. The functional relevance of 120 coronary lesions was assessed by FFR in 47 patients with severe AVS. Comparison of variables before and after TAVI was performed using a paired Student’s t-test.
No significant overall change in FFR values was found before and after TAVI (0.88±0.10 vs (0.89±0.12, p=0.65). Positive FFR values at baseline (≤0.8), worsened after TAVI: 0.71±0.11 vs 0.65±0.13, p=0.001. Conversely, negative FFR values at baseline improved: 0.91±0.05 vs 0.93±0.07, p=0.01. Similarly, FFR values in arteries with mild lesions (%DS<50) improved after TAVI (0.92±0.06 vs 0.93±0.07, p=0.03), while lesions with %DS>50 tended toward worsening (0.82±0.12 vs 0.80±0.16, p=0.17). Functional FFR variations after TAVI changed the indication to treat the coronary stenosis in 7 out of 120 (5.8%) of lesions, (15% of patients).
Coronary hemodynamics are influenced by AVS removal. Nevertheless, FFR variations after TAVI are minor and crossed the diagnostic cut-off 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.
IMAGING: FFR and Physiologic Lesion Assessment