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The coronary and microcirculatory measurements in patients with aortic valve stenosis study: rationale and design

Lennert Minten1,2, Keir McCutcheon1,2, Sander Jentjens3

  • 1Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Leuven, Belgium.

American Journal of Physiology. Heart and Circulatory Physiology
|October 22, 2021
PubMed

Insights

Aortic stenosis treatment improves coronary blood flow assessment. Fractional flow reserve (FFR) and other indices become more accurate after aortic valve replacement (AVR), aiding decisions for coronary artery disease (CAD) in AS patients.

Area of Science:

  • Cardiology
  • Cardiovascular Surgery
  • Interventional Cardiology

Background:

  • Concomitant coronary artery disease (CAD) is common in severe aortic stenosis (AS).
  • Myocardial remodeling in AS complicates hemodynamic assessment of CAD severity.
  • Current indices like fractional flow reserve (FFR) may be unreliable in AS patients.

Purpose of the Study:

  • To investigate the impact of AS and its treatment on CAD evaluation indices.
  • To compare intracoronary hemodynamics before and after aortic valve replacement (AVR).
  • To assess changes in FFR, resting full-cycle ratio (RFR), and microvascular function post-AVR.

Main Methods:

  • Prospective study of 100 patients with AS and intermediate CAD.
  • Intracoronary hemodynamic assessment and SPECT at baseline, immediately post-TAVR (if applicable), and 6 months post-AVR.
  • Comparison of FFR and RFR against SPECT for ischemia detection.

Main Results:

  • Primary endpoint: change in FFR at 6 months post-AVR.
  • Secondary endpoints: acute FFR changes post-TAVR, diagnostic accuracy of FFR/RFR vs. SPECT, microvascular function changes (IMR), and their effect on FFR.
  • Evaluation of intracoronary hemodynamic parameters across different time points relative to AVR.

Conclusions:

  • Aortic valve replacement improves the reliability of hemodynamic indices for CAD assessment in AS patients.
  • Understanding these changes aids in guiding revascularization decisions for AS patients with CAD.
  • This study provides insights into microvascular function recovery post-AVR.

Keywords:
aortic valve stenosiscoronary artery diseasemicrovascular dysfunctiontranslational clinical research

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