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Coronary Physiological Indexes to Evaluate Myocardial Ischemia in Patients With Aortic Stenosis Undergoing Valve

Lennert Minten1, Keir McCutcheon2, Maarten Vanhaverbeke3

  • 1Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium; Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven Belgium.

JACC. Cardiovascular Interventions
|October 30, 2024
PubMed

Insights

In patients with severe aortic stenosis and coronary artery disease, new cutoff values for fractional flow reserve (FFR) and resting full-cycle ratio (RFR) can accurately predict myocardial ischemia. Aortic valve replacement improves microvascular function and reduces left ventricular mass.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Evaluating myocardial ischemia in patients with aortic stenosis (AS) and coronary artery disease (CAD) is complex due to potential microvascular dysfunction (MVD).
  • Fractional flow reserve (FFR) and resting full-cycle ratio (RFR) lack validation in this specific clinical scenario.

Purpose of the Study:

  • To define the relationship between hyperemic and resting indices in AS patients with CAD.
  • To assess the impact of aortic valve replacement (AVR) on epicardial and microvascular function.
  • To establish accurate FFR/RFR cutoff points for diagnosing ischemia in AS.

Main Methods:

  • Prospective, multicenter study involving serial FFR and RFR measurements.
  • Evaluation of MVD using coronary flow reserve and microvascular resistance indices.
  • Measurements taken before and 6 months after AVR in patients with severe AS and intermediate to severe CAD.

Main Results:

  • Significant FFR/RFR discordance observed before AVR.
  • Acutely post-AVR, FFR decreased while RFR remained stable; long-term, FFR decreased and RFR increased significantly.
  • Left ventricular mass decreased, and microvascular function improved post-AVR.
  • FFR ≤0.83 and RFR ≤0.85 demonstrated the highest accuracy in predicting ischemia.

Conclusions:

  • FFR ≤0.83 and RFR ≤0.85 are accurate predictors of myocardial ischemia in severe AS and CAD.
  • AVR leads to significant changes in FFR and RFR, reduced left ventricular mass, and improved microvascular function.
Abstract

Keywords:
aortic valve replacementaortic valve stenosiscoronary artery diseasecoronary flow reservecoronary physiologyfractional flow reserveindex of microvascular resistancemicrovascular functionmicrovascular resistance reservenonhyperemic pressure ratioresting full-cycle ratiosingle-photon emission computed tomographytranscatheter aortic valve replacement

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