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The Influence of Aortic Valve Obstruction on the Hyperemic Intracoronary Physiology: Difference Between Resting Pd/Pa and FFR in Aortic Stenosis

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Abstract

The reliability of fractional flow reserve (FFR) in aortic stenosis (AS) has been questioned because of the uncertain response to vasodilators. A retrospective multicenter cohort of 114 AS patients who underwent coronary physiology assessment was compared with 154 controls before and after propensity matching adjustment. The difference between resting distal coronary vs aortic pressure ratio (Pd/Pa) and FFR (ΔPd/Pa-FFR) was tested against the severity of AS. ΔPd/Pa-FFR was not influenced by the severity of AS in terms of aortic valve area (r = − 0.02, p = 0.83) and gradient (r = − 0.05, p = 0.64) or by the left ventricle hypertrophy (r = − 0.03, p = 0.88). Conversely, ΔPd/Pa-FFR was influenced by the presence of diabetes (r = − 0.24, p = 0.005), peripheral vascular disease (r = − 0.16, p = 0.047), and chronic kidney disease (r = − 0.19, p = 0.03). No significant difference was observed in the ΔPd/Pa-FFR between patients with AS and matched controls. Further studies are warranted to validate the FFR-guided revascularization in patients with AS.

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Abbreviations

AS:

Aortic stenosis

CAD:

Coronary artery disease

CKD:

Chronic kidney disease

DS:

Diameter stenosis

FFR:

Fractional flow reserve

iFR:

Instantaneous wave-free ratio

LAD:

Left anterior descending artery

LV:

Left ventricle

Pd/Pa:

Distal vs proximal coronary pressure ratio

QCA:

Quantitative coronary analysis

TAVI:

Transcatheter aortic valve implantation

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Author notes

  1. Roberto Scarsini and Giovanni L. De Maria contributed equally to this work.

Authors and Affiliations

  1. Oxford Heart Centre, Oxford University Hospitals, NHS Trust, Oxford, UK

    Roberto Scarsini, Giovanni L. De Maria, Rafail A. Kotronias, Rajesh K. Kharbanda & Adrian Banning

  2. Department of Medicine, Division of Cardiology, University of Verona, Piazzale Aristide Stefani 1, 37126, Verona, Italy

    Roberto Scarsini, Gabriele Pesarini & Flavio Ribichini

  3. Department of Cardiology, Policlinico Gemelli, Università La Sapienza, Rome, Italy

    Giovanni L. De Maria, Cristina Aurigemma, Giuseppe Zimbardo, Francesco Burzotta, Antonio M. Leone, Carlo Trani & Filippo Crea

  4. Department of Cardiology, Cardiovascular Research Centre, OLV Hospital, Aalst, Belgium

    Giuseppe Di Gioia, Bernard De Bruyne & Emanuele Barbato

  5. Division of Cardiology, Department of Advanced Biomedical Science, University of Naples Federico II, Naples, Italy

    Giuseppe Di Gioia & Emanuele Barbato

Authors
  1. Roberto Scarsini
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  2. Giovanni L. De Maria
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  3. Giuseppe Di Gioia
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  4. Rafail A. Kotronias
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Corresponding author

Correspondence to Flavio Ribichini.

Ethics declarations

The local review board of other centers involved approved the study.

Conflict of Interest

Dr. Scarsini received an EAPCI education and training fellowship grant. Dr. Di Gioia is supported by CardioPaTh PhD program. Prof Banning received institutional funding for an interventional fellowship from Bosoton Scientific. Prof Banning is partially funded by the NHS NIHR Biomedical Reseach Centre, Oxford. Other authors have no conflict of interest to declare.

Human Subject/Informed Consent Statement

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000 [5]. Informed consent was obtained from all patients included in the study.

Additional information

Associate Editor Ana Barac oversaw the review of this article.

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Electronic Supplementary Material

Supplementary figure 1.

Patient screening and selection. (PDF 43 kb)

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Scarsini, R., De Maria, G.L., Di Gioia, G. et al. The Influence of Aortic Valve Obstruction on the Hyperemic Intracoronary Physiology: Difference Between Resting Pd/Pa and FFR in Aortic Stenosis. J. of Cardiovasc. Trans. Res. 12, 539–550 (2019). https://doi.org/10.1007/s12265-019-09890-5

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  • DOI: https://doi.org/10.1007/s12265-019-09890-5

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