scholarly journals The COronary and MICrocirculatory measurements in patients with Aortic valve Stenosis (COMIC-AS) study: Rationale and design

2021 ◽  
Author(s):  
Lennert Minten ◽  
Keir McCutcheon ◽  
Sander Jentjens ◽  
Maarten Vanhaverbeke ◽  
Vincent F.M. Segers ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Valve Replacement ◽  
Myocardial Perfusion Spect ◽  
Microvascular Function ◽  
Fractional Flow ◽  
Flow Reserve ◽  
Hemodynamic Assessment ◽  
Index Of Microcirculatory Resistance ◽  
Artery Disease ◽  
The Impact

Objective: Although coronary artery disease (CAD) is frequent in patients with aortic stenosis (AS), hemodynamic assessment of CAD severity in patients undergoing valve replacement for severe AS is challenging. Myocardial hypertrophic remodelling interferes with coronary blood flow and may influence the values of fractional flow reserve (FFR) and non-hyperemic pressure ratios (NHPRs). The aim is to investigate these effects on current CAD indices by comparing intra-coronary hemodynamics prior to, immediately after and six months after aortic valve replacement (AVR), when it is expected that microvascular function has improved. Furthermore, we will compare FFR and Resting Full Cycle Ratio (RFR) with myocardial perfusion SPECT as indicators of myocardial ischemia in patients with AS and CAD. Study design: One hundred patients with AS and CAD will be prospectively included. Patients will undergo pre-AVR SPECT and intra-coronary hemodynamic assessment at baseline, immediately after and six months after AVR. The primary endpoint is the change in FFR. Secondary endpoints include the acute change of FFR after TAVR, the diagnostic accuracy of FFR versus RFR compared with SPECT for the assessment of ischemia, changes in microvascular function as assessed by the index of microcirculatory resistance (IMR), and the effect of these changes on FFR.Conclusion: The present study will evaluate intra-coronary physiology before, immediately after and six months after AVR in patients with AS and intermediate coronary stenosis. The understanding of the impact of AVR on the assessment of FFR, NHPR and microvascular function may help guide the need for revascularization in these patients.

P7 The impact of coronary calcification on diagnostic performance of workstation CT derived fractional flow reserve - a multicentre experience

2020 ◽  
Vol 41 (Supplement_1) ◽  
Author(s):  
A R Ihdayhid ◽  
S Motoyama ◽  
S Fujimoto ◽  
M Isa ◽  
N Nerlekar ◽  
...  
Keyword(s):  
Fractional Flow Reserve ◽  
Diagnostic Performance ◽  
Coronary Calcification ◽  
Pooled Analysis ◽  
Agatston Score ◽  
Fractional Flow ◽  
Reduced Order ◽  
Flow Reserve ◽  
Artery Disease ◽  
The Impact

Abstract Background On-site workstation based computed tomography derived fractional flow reserve (CT-FFR) is an emerging method to assess the vessel specific ischaemia in coronary artery disease (CAD). The impact of coronary calcification on its diagnostic performance is unknown. Purpose To evaluate the impact of coronary calcification on the diagnostic performance of reduced-order CT-FFR at detecting vessel specific ischaemia. Methods This is a retrospective pooled analysis of 141 patients with suspected CAD enrolled from 3 global centres who underwent CT-coronary angiography (CTA), onsite CT-FFR and invasive FFR.  Coronary calcification was assessed by Agatston score (AS). The diagnostic performance of CT-FFR (≤0.8) and CTA (≥50%) in evaluation of vessel specific ischaemia (FFR ≤ 0.8) was assessed across AS quartiles (Q1-4). A comparison of diagnostic performance of the low to mid AS (Q1 to Q3) versus high AS (Q4) was performed. Results Mean age and median AS was 65.8 ± 9.9 and 327.3 (interquartile range = 78.5 – 798.1). Diagnostic accuracy, sensitivity and specificity of CT-FFR for low-mid AS (0-798) and high AS (799-4019) were 77.4% vs 82.9%; 78.9% vs 94.7%; 68.8% vs 76.5% respectively with no statistical difference between the two groups.  The AUC for ischaemia of CT-FFR in low to mid AS was comparable with AUC in the high AS (0.76 [95% CI: 0.66-0.86] vs 0.84 [0.69-0.99]; P = 0.397).  The AUC for ischemia for CT-FFR in both low to mid AS and high AS was significantly higher than for CTA (0.76 [0.66-0.86] vs 0.57 [0.50-0.64]; P = 0.003 and 0.84 [0.69-0.99] vs 0.48 [0.38-0.57]; P < 0.001 respectively). Conclusion On-site workstation CT-FFR demonstrated consistently high diagnostic performance in patients with high AS. Its diagnostic performance was superior when compared with significant stenosis assessment on CTA across all spectrum of Agatston scores.

6115Influence of microvascular function and coronary flow in the diagnostic precision of resting full-cycle ratio

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M A Tamargo Delpon ◽  
E Gutierrez Ibanes ◽  
F Diez-Delhoyo ◽  
H Gonzalez-Saldivar ◽  
A R Rivera ◽  
...  
Keyword(s):  
Coronary Flow ◽  
Microvascular Function ◽  
P Value ◽  
Fractional Flow ◽  
Coronary Physiology ◽  
Flow Reserve ◽  
Significant Difference ◽  
Index Of Microcirculatory Resistance ◽  
Good Concordance ◽  
Physiology Parameters

Abstract Introduction Resting full-cycle ratio (RFR) has been recently described as a non-hyperemic index of coronary stenosis with good concordance with Fractional Flow Reserve (FFR). However, there is no information concerning the influence of microvascular function and coronary flow on RFR results. Purpose To determine if the accuracy of this novel parameter might be influenced by changes in microvascular function. Methods 133 patients admitted in our center between July 2016 and December 2017 underwent coronary physiology study of an angiographically intermediate lesion. 67 subjects presented with AMI and an intermediate lesion in a non-culprit artery, and 66 subjects stable coronary disease. We performed FFR, Coronary Flow Reserve (CFR), Index of Microcirculatory Resistance (IMR) and Resistance Reserve Ratio (RRR) in all of them. We calculated RFR retrospectively from the pressure tracings. Results Coronary physiology parameters showed a non-normal distribution and are presented as median [IQR]: FFR 0.86 [0.79–0.92]; CFR 2.05 [1.4–2.95]; IMR 20.5 [14–32.55]; RRR 2.5 [1.85–3.63]; RFR 0.897 [0.83–0.94]. Patients with abnormal CFR displayed lower RFR values although FFR was not markedly affected (Table 1). These findings remained irrespective of the clinical scenario at presentation. 61 patients had a CFR lower than 2. Correlation between RFR and FFR was not significantly different in patients with abnormal CFR than in those with normal CFR (0,73 vs 0,88; p=0,067) (Figure 1); however, overall binary agreement between RFR and FFR was worse in patients with a low CFR (69% vs 83%; p=0,047). 48 patients had a high IMR (>25). Linear correlation between RFR and FFR was similar in patients with high and normal IMR (0,81 vs 0,83; p=0,784); likewise, binary concordance showed no significant difference between both groups (77% vs 75%, p=0,78). The mean difference between RFR and FFR was 0,025. This was only influenced by CFR: patients with a low CFR had a smaller difference than those with a normal CFR (0,012 vs 0,035; p=0,019). Physiology parameters by CFR group Normal CFR (≥2) Low CFR (<2) P-value FFR 0.88 [0.82–0.93] 0.84 [0.79–0.92] 0.14 RFR 0.91 [0.88–0.95] 0.86 [0.80–0.92] 0.0009 IMR 16.5 [13–27] 25 [16–45.5] 0.002 RRR 3.6 [2.7–4.9] 1.7 [1.3–2.1] <0.0001 Physiological coronary parameters (Median [IQR]) according to CFR. Correlation between RFR and FFR by CFR Conclusion RFR has good overall correlation and concordance with FFR. However, RFR has a lower diagnostic accuracy in patients with a low CFR. Acknowledgement/Funding None

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