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Functional assessment of coronary artery disease in patients with severe aortic stenosis: a review

Eron Yones1,2, Julian Gunn3,2, Javaid Iqbal3,2

  • 1School of Clinical Medicine and Population Health, The University of Sheffield, Sheffield, UK eron.yones2@nhs.net.

Heart (British Cardiac Society)
|December 12, 2024
PubMed

Insights

Assessing coronary artery disease (CAD) in severe aortic stenosis (AS) patients undergoing transcatheter aortic valve implantation (TAVI) is challenging. This review summarizes current data on functional CAD assessment in this population to guide optimal treatment strategies.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Many patients with severe aortic stenosis (AS) also have coronary artery disease (CAD).
  • Optimal management strategies for concomitant severe AS and CAD, particularly during transcatheter aortic valve implantation (TAVI), remain debated.
  • Current methods for assessing myocardial ischemia, like fractional flow reserve (FFR), are not validated in severe AS.

Purpose of the Study:

  • To review current data on functional coronary artery disease (CAD) assessment in patients with severe aortic stenosis (AS).
  • To highlight best practices for managing CAD in patients undergoing transcatheter aortic valve implantation (TAVI).

Main Methods:

  • Review of existing prospective and observational studies on coronary physiology assessment in severe AS.
  • Analysis of data from studies evaluating hyperemic and resting indices before and after TAVI.
  • Examination of the limited randomized trial data on FFR-guided revascularization in TAVI patients.

Main Results:

  • Limited evidence exists for routine FFR use in guiding revascularization during TAVI.
  • Observational studies show changes in coronary indices in severe AS patients before and after TAVI.
  • There is a need for better understanding and interpretation of coronary physiology in this specific patient group.

Conclusions:

  • Functional assessment of CAD in severe AS patients undergoing TAVI requires further investigation.
  • Current guidelines for ischemia assessment may not directly apply to patients with severe AS.
  • Optimizing treatment pathways necessitates a clearer understanding of coronary physiology in this complex population.

Keywords:
Aortic Valve StenosisCoronary VesselsPercutaneous Coronary InterventionTranscatheter Aortic Valve Replacement

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