Differential Effect of Aortic Valve Replacement for Severe Aortic Stenosis on Hyperemic and Resting Epicardial Coronary Pressure Indices.
J Am Heart Assoc
; 13(10): e034401, 2024 May 21.
Article
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| MEDLINE
| ID: mdl-38761080
ABSTRACT
BACKGROUND:
Coronary pressure indices to assess coronary artery disease are currently underused in patients with aortic stenosis due to many potential physiological effects that might hinder their interpretation. Studies with varying sample sizes have provided us with conflicting results on the effect of transcatheter aortic valve replacement (TAVR) on these indices. The aim of this meta-analysis was to study immediate and long-term effects of TAVR on fractional flow reserve (FFR) and nonhyperemic pressure ratios (NHPRs). METHODS ANDRESULTS:
Lesion-specific coronary pressure data were extracted from 6 studies, resulting in 147 lesions for immediate change in FFR analysis and 105 for NHPR analysis. To investigate the long-term changes, 93 lesions for FFR analysis and 68 for NHPR analysis were found. Lesion data were pooled and compared with paired t tests. Immediately after TAVR, FFR decreased significantly (-0.0130±0.0406 SD, P 0.0002) while NHPR remained stable (0.0003±0.0675, P 0.9675). Long-term after TAVR, FFR decreased significantly (-0.0230±0.0747, P 0.0038) while NHPR increased nonsignificantly (0.0166±0.0699, P 0.0543). When only borderline NHPR lesions were considered, this increase became significant (0.0249±0.0441, P 0.0015). Sensitivity analysis confirmed our results in borderline lesions.CONCLUSIONS:
TAVR resulted in small significant, but opposite, changes in FFR and NHPR. Using the standard cut-offs in patients with severe aortic stenosis, FFR might underestimate the physiological significance of a coronary lesion while NHPRs might overestimate its significance. The described changes only play a clinically relevant role in borderline lesions. Therefore, even in patients with aortic stenosis, an overtly positive or negative physiological assessment can be trusted.Palabras clave
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Banco de datos:
MEDLINE
Asunto principal:
Estenosis de la Válvula Aórtica
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Índice de Severidad de la Enfermedad
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Reserva del Flujo Fraccional Miocárdico
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Reemplazo de la Válvula Aórtica Transcatéter
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Hiperemia
Límite:
Humans
Idioma:
En
Revista:
J Am Heart Assoc
Año:
2024
Tipo del documento:
Article