Pesarini Gabriele, Scarsini Roberto, Zivelonghi Carlo, Piccoli Anna, Gambaro Alessia, Gottin Leonardo, Rossi Andrea, Ferrero Valeria, Vassanelli Corrado, Ribichini Flavio
From the Division of Cardiology, Department of Medicine, School of Medicine (G.P., R.S., C.Z., A.P., A.G., A.R., V.F., C.V., F.R.) and Department of Anesthesia and Intensive Care (L.G.), University of Verona, Italy.
Circ Cardiovasc Interv. 2016 Nov;9(11). doi: 10.1161/CIRCINTERVENTIONS.116.004088.
Aortic valve stenosis may influence fractional flow reserve (FFR) of concomitant coronary artery disease by causing hypertrophy and reducing the vasodilatory reserve of the coronary circulation. We sought to investigate whether FFR values might change after valve replacement.
The functional relevance of 133 coronary lesions was assessed by FFR in 54 patients with severe aortic valve stenosis before and after transcatheter aortic valve implantation (TAVI) during the same procedure. A linear mixed model was used to verify the interaction of TAVI effect with the FFR values. No significant overall change in FFR values was found before and after the aortic valve stenosis removal (0.89±0.10 versus 0.89±0.13; P=0.73). A different trend in FFR groups (positive if ≤0.8; negative if >0.8) was found after TAVI (P for interaction <0.001). Positive FFR values worsened after TAVI (0.71±0.11 versus 0.66±0.14). Conversely, negative FFR values improved after TAVI (0.92±0.06 versus 0.93±0.07). Similarly, FFR values in coronary arteries with lesions presenting percent diameter stenosis >50 worsened after TAVI (0.84±0.12 versus 0.82±0.16; P=0.02), whereas FFR values in arteries with mild lesions (percent diameter stenosis <50) tended toward improvement after TAVI (0.90±0.07 versus 0.91±0.09; P=0.69). Functional FFR variations after TAVI changed the indication to treat the coronary stenosis in 8 of 133 (6%) lesions.
Coronary hemodynamics are influenced by aortic valve stenosis removal. Nevertheless, FFR variations after TAVI are minor and crossed the diagnostic cutoff of 0.8 in a small number of patients after valve replacement. Borderline coronary lesions might become functionally significant after valve replacement, although FFR-guided interventions were infrequent even in patients with angiographically significant lesions.
主动脉瓣狭窄可能通过导致心肌肥厚和降低冠状动脉循环的血管舒张储备来影响合并存在的冠状动脉疾病的血流储备分数（FFR）。我们旨在研究瓣膜置换术后FFR值是否会发生变化。
在54例严重主动脉瓣狭窄患者行经导管主动脉瓣植入术（TAVI）的过程中，于术前和术后通过FFR评估了133处冠状动脉病变的功能相关性。采用线性混合模型来验证TAVI效应与FFR值之间的相互作用。在解除主动脉瓣狭窄前后，未发现FFR值有显著的总体变化（0.89±0.10对0.89±0.13；P=0.73）。TAVI术后发现FFR分组（≤0.8为阳性，>0.8为阴性）有不同的趋势（交互作用P<0.001）。阳性FFR值在TAVI术后恶化（0.71±0.11对0.66±0.14）。相反，阴性FFR值在TAVI术后改善（0.92±0.06对0.93±0.07）。同样，直径狭窄百分比>50%的病变冠状动脉的FFR值在TAVI术后恶化（0.84±0.12对0.82±0.16；P=0.02），而轻度病变（直径狭窄百分比<50%）的动脉FFR值在TAVI术后有改善趋势（0.90±0.07对0.91±0.09；P=0.69）。TAVI术后FFR的功能变化改变了133处病变中8处（6%）冠状动脉狭窄的治疗指征。
冠状动脉血流动力学受主动脉瓣狭窄解除的影响。然而，TAVI术后FFR的变化较小，且在少数瓣膜置换术后患者中超过了0.8的诊断临界值。尽管即使在血管造影显示有明显病变的患者中，FFR指导的干预也不常见，但临界冠状动脉病变在瓣膜置换术后可能会在功能上变得显著。
