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Quantitative flow ratio-based outcomes in patients undergoing transcatheter aortic valve implantation quaestio study
Pierluigi Demola1, Iginio Colaiori1, Davide Bosi1
1Cardiology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.
Insights
Quantitative Flow Ratio (QFR) analysis identifies coronary artery disease (CAD) in patients undergoing Transcatheter Aortic Valve Implantation (TAVI). Positive QFR indicates a higher risk of mortality and major adverse cardiovascular events post-TAVI.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Medical Imaging
Background:
- Coronary artery disease (CAD) is prevalent in severe aortic valve stenosis (AS) patients (60-80%).
- The prognostic significance of coronary lesions in Transcatheter Aortic Valve Implantation (TAVI) candidates is not fully understood.
- This study investigates long-term outcomes using Quantitative Flow Ratio (QFR) for CAD assessment in severe AS patients undergoing TAVI.
Purpose of the Study:
- To evaluate the clinical utility of pre-TAVI Quantitative Flow Ratio (QFR) for characterizing coronary artery disease (CAD).
- To assess the association between QFR-defined CAD and long-term clinical outcomes in patients with severe aortic valve stenosis (AS) undergoing TAVI.
- To determine if QFR can identify high-risk patients eligible for TAVI.
Main Methods:
- Retrospective analysis of 439 invasive coronary angiographies from TAVI-eligible patients with symptomatic severe AS.
- Quantitative Flow Ratio (QFR) analysis was performed to assess coronary artery lesions.
- Primary endpoint: all-cause mortality. Secondary endpoint: composite of cardiovascular mortality, stroke/TIA, AMI, and hospitalization post-TAVI.
Main Results:
- 20.1% of patients (48/239) had a positive QFR (≤0.80).
- Positive QFR was independently associated with increased all-cause mortality (HR 5.01; 95% CI, 3.17-7.90) after adjustment.
- QFR positivity in the Left Anterior Descending artery (LAD) was linked to a higher risk of the composite outcome compared to no positive QFR or non-LAD QFR positivity.
Conclusions:
- Pre-TAVI QFR offers a safe, simple, and wireless method for functional assessment of CAD.
- QFR can effectively identify patients at high risk for cardiovascular mortality and Major Adverse Cardiovascular Events (MACE).
- QFR assessment should be considered by Heart Teams for guiding TAVI patient management.
Background:
Coronary artery disease (CAD) is common in patients with aortic valve stenosis (AS) ranging from 60% to 80%. The clinical and prognostic role of coronary artery lesions in patients undergoing Transcatheter Aortic Valve Implantation (TAVI) remains unclear. The aim of the present observational study was to estimate long-term clinical outcomes by Quantitative Flow Ratio (QFR) characterization of CAD in a well-represented cohort of patients affected by severe AS treated by TAVI.
Methods:
A total of 439 invasive coronary angiographies of patients deemed eligible for TAVI by local Heart Teams with symptomatic severe AS were retrospectively screened for QFR analysis. The primary endpoint of the study was all-cause mortality. The secondary endpoint was a composite of cardiovascular mortality, stroke/transient ischemic attack (TIA), acute myocardial infarction (AMI), and any hospitalization after TAVI.
Results:
After exclusion of patients with no follow-up data, coronary angiography not feasible for QFR analysis and previous surgical myocardial revascularization (CABG) 48/239 (20.1%) patients had a QFR value lower or equal to 0.80 (QFR + value), while the remaining 191/239 (79.9%) did not present any vessel with a QFR positive value. In the adjusted Cox regression analysis, patients with positive QFR were independently associated with an increased risk of all-casual mortality (Model 1, HR 3.47, 95% CI, 2.35-5.12; Model 2, HR 5.01, 95% CI, 3.17-7.90). In the adjusted covariate analysis, QFR+ involving LAD (37/48, 77,1%) was associated with the higher risk of the composite outcome compared to patients without any positive value of QFR or non-LAD QFR positive value (11/48, 22.9%).
Conclusions:
Pre-TAVI QFR analysis can be used for a safe, simple, wireless functional assessment of CAD. QFR permits to identify patients at high risk of cardiovascular mortality or MACE, and it could be considered by local Heart Teams.
