Author + information
- 1University of Verona, Verona, Verona, Italy
- 2Ospedale Civile Maggiore Borgo Trento, Verona, Verona, Italy
- 3Division of Cardiology, Department of Medicine, University of Verona, Verona, Verona, Italy
- 4Division of Cardiology, University of Verona, Verona, Verona, Italy
- 5University of Verona, Verona, Verona, Italy
The complexity of coronary physiology in presence of severe aortic stenosis (AS) raises concerns about the reliability of pressure-derived indexes in this clinical setting. Furthermore neither fractional flow reserve (FFR) nor instantaneous wave-free period (iFR) have been validated in AS. Combining iFR and FFR in a tailored decision-making strategy may help to increase the accuracy and the safety of physiology-guided revascularization in AS.
In this prospective observational study iFR and FFR were measured before and after TAVI during the same procedure in patients with severe AS and concomitant coronary artery disease (CAD). All decisions about revascularization were based on post-TAVI FFR assessment. The best iFR defer and treatment values were identified according to their negative (NPV) and positive predictive values (PPV) respectively. A post-hoc analysis was then performed to compare the hybrid iFR-FFR approach with the FFR-only strategy.
A total of 74 patients with severe AS patients with 145 coronary lesions were included in the analysis.A “defer iFR value” >0.93 yielded a NPV= 98.4% (91.7%-99.9%) to exclude FFR non-significant stenosis (>0.80), and a “treatment iFR value” <0.83 had a PPV of 91.3% (72%-98.9%) to identify FFR-significant stenosis (≤0.80). A hybrid decision-making strategy based on iFR and FFR spared 63% of patients from adenosine, while maintaining 97% overall agreement with FFR lesions classification.
A hybrid iFR-FFR diagnostic strategy is feasible in patients with severe AS undergoing TAVI and allows to spare the majority of patients from adenosine, while maintaining an elevated agreement with FFR classification of coronary lesions.
IMAGING: FFR and Physiologic Lesion Assessment