1. Long-Term Effects of Transcatheter Aortic Valve Implantation on Coronary Hemodynamics in Patients With Concomitant Coronary Artery Disease and Severe Aortic Stenosis
- Author
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Christian Juhl Terkelsen, Valérie E. Stegehuis, Jeroen Vendrik, Evald Høj Christiansen, Gilbert Wijntjens, Sayan Sen, Jan J. Piek, Karel T. Koch, James P. Howard, Jan Baan, Yousif Ahmad, Ashkan Eftekhari, Christopher Cook, ACS - Atherosclerosis & ischemic syndromes, ACS - Microcirculation, Graduate School, Cardiology, Amsterdam Cardiovascular Sciences, APH - Aging & Later Life, ACS - Pulmonary hypertension & thrombosis, and ACS - Heart failure & arrhythmias
- Subjects
Male ,Time Factors ,Physiology ,coronary flow reserve ,aortic valve stenosis ,Fractional flow reserve ,TAVR/TAVI ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,ventricular remodeling ,Coronary artery disease ,0302 clinical medicine ,transcutaneous aortic valve implantation ,Catheter-Based Coronary and Valvular Interventions ,Coronary hemodynamics ,030212 general & internal medicine ,fractional flow reserve ,Original Research ,Aged, 80 and over ,Interventional Cardiology ,Fractional Flow Reserve, Myocardial ,Treatment Outcome ,Editorial ,Aortic valve stenosis ,Cardiology ,coronary hemodynamic ,Female ,Cardiology and Cardiovascular Medicine ,medicine.medical_specialty ,Diastole ,Transcatheter Aortic Valve Replacement ,03 medical and health sciences ,Internal medicine ,Coronary Circulation ,medicine ,Humans ,aortic valve replacement ,Ventricular remodeling ,Aged ,business.industry ,Hemodynamics ,Coronary Stenosis ,Editorials ,medicine.disease ,coronary flow ,Stenosis ,Concomitant ,Vascular Resistance ,business ,Follow-Up Studies - Abstract
Background As younger patients are being considered for transcatheter aortic valve implantation (TAVI), the assessment and treatment of concomitant coronary artery disease is taking on increased importance. Methods and Results Thirteen contemporary lower‐risk patients with TAVI with severe aortic stenosis (AS) and moderate‐severe coronary lesions were included. Patients underwent assessment of coronary hemodynamics in the presence of severe AS (pre‐ TAVI ), in the absence of severe AS (immediately post‐ TAVI ), and at longer‐term follow‐up (6 months post‐ TAVI ). Fractional flow reserve decreased from 0.85 (0.76–0.88) pre‐ TAVI to 0.79 (0.74–0.83) post‐ TAVI , and then to 0.71 (0.65–0.77) at 6‐month follow‐up ( P TAVI , 0.83 (0.77–0.88) post‐ TAVI , and 0.83 (0.73–0.89) at 6 months ( P =0.735). These changes are explained by the underlying coronary flow. Hyperemic whole‐cycle coronary flow (fractional flow reserve flow) increased from 26.36 cm/s (23.82–31.82 cm/s) pre‐ TAVI to 30.78 cm/s (29.70–34.68 cm/s) post‐ TAVI ( P =0.012), to 40.20 cm/s (32.14–50.00 cm/s) at 6‐month follow‐up ( P TAVI , 24.54 cm/s (20.74–27.88 cm/s) post‐ TAVI , and 25.89 cm/s (22.57–28.96 cm/s) at 6 months ( P =0.500). Conclusions TAVI acutely improves whole‐cycle hyperemic coronary flow, with ongoing sustained improvements at longer‐term follow‐up. This enhanced response to hyperemic stimuli appears to make fractional flow reserve assessment less suitable for patients with severe AS. Conversely, resting diastolic flow is not significantly influenced by the presence of severe AS. Resting indices of coronary stenosis severity, therefore, appear to be more appropriate for this patient population, although large‐scale prospective randomized trials will be required to determine the role of coronary physiology in patients with severe AS.
- Published
- 2020
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