Diagnostic Accuracy of Pre-Transcatheter Aortic Valve Replacement Nitroglycerin-Free Fractional Flow Reserve-Computed Tomography-Based Physiological Assessment in Patients With Severe Aortic Stenosis for Predicting Post-Transcatheter Aortic Valve Replacement Ischemia.

Abstract

BACKGROUND:

Fractional flow reserve-computed tomography (FFRCT) has not been validated in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR) for coronary artery disease due to theoretical difficulties in using nitroglycerin for such patients.Methods and Results: In this single-center study, we prospectively enrolled 21 patients (34 vessels) and performed pre-TAVR FFRCTwithout nitroglycerin, pre-TAVR invasive instantaneous wave-free ratio (iFR) measurements, and post-TAVR FFR measurements using a pressure wire. The diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of pre-TAVR FFRCT≤0.80 to predict post-TAVR invasive FFR ≤0.80 were 82%, 83%, 82%, 71%, and 90%, respectively. A receiver operating characteristic analysis demonstrated an optimal cutoff of 0.78 for pre-TAVR FFRCTto indicate post-TAVR FFR ≤0.80, with an area under the curve (AUC) of 0.84, and the counterpart cutoff of pre-TAVR iFR was 0.89 with an AUC of 0.86.

CONCLUSIONS:

FFRCTwithout nitroglycerin could be a useful non-invasive imaging modality for assessing the severity of coronary artery lesions in patients with severe AS.

• Authors: Satoru Sasaki, Hiroyuki Kawamori, Takayoshi Toba, Ryo Takeshige, Yusuke Fukuyama, Takashi Hiromasa, Hiroyuki Fujii, Tomoyo Hamana, Yuto Osumi, Seigo Iwane, Tetsuya Yamamoto, Shota Naniwa, Yuki Sakamoto, Koshi Matsuhama, Yuta Fukuishi, Toshiro Shinke, Ken-Ichi Hirata, Hiromasa Otake
• Journal: Circulation journal : official journal of the Japanese Circulation Society (Circ J) Vol. 88 Issue 4 Pg. 501-509 (Mar 25 2024) ISSN: 1347-4820 [Electronic] Japan
• PMID: 37813600 (Publication Type: Journal Article)

Chemical References

• Nitroglycerin

Topics

• Humans
• Transcatheter Aortic Valve Replacement
• Fractional Flow Reserve, Myocardial (physiology)
• Nitroglycerin
• Aortic Valve Stenosis (diagnostic imaging, surgery)
• Prospective Studies
• Coronary Artery Disease (surgery)
• Tomography, X-Ray Computed
• Predictive Value of Tests
• Coronary Vessels
• Ischemia (surgery)
• Coronary Angiography (methods)
• Severity of Illness Index
• Coronary Stenosis