Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine.
Division of Cardiology, Showa University School of Medicine.
Circ J. 2024 Mar 25;88(4):501-509. doi: 10.1253/circj.CJ-23-0312. Epub 2023 Oct 7.
Fractional flow reserve-computed tomography (FFR) has not been validated in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR) for coronary artery disease due to theoretical difficulties in using nitroglycerin for such patients.
In this single-center study, we prospectively enrolled 21 patients (34 vessels) and performed pre-TAVR FFRwithout nitroglycerin, pre-TAVR invasive instantaneous wave-free ratio (iFR) measurements, and post-TAVR FFR measurements using a pressure wire. The diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of pre-TAVR FFR≤0.80 to predict post-TAVR invasive FFR ≤0.80 were 82%, 83%, 82%, 71%, and 90%, respectively. A receiver operating characteristic analysis demonstrated an optimal cutoff of 0.78 for pre-TAVR FFRto indicate post-TAVR FFR ≤0.80, with an area under the curve (AUC) of 0.84, and the counterpart cutoff of pre-TAVR iFR was 0.89 with an AUC of 0.86.
FFRwithout nitroglycerin could be a useful non-invasive imaging modality for assessing the severity of coronary artery lesions in patients with severe AS.
由于对这类患者使用硝酸甘油存在理论上的困难，因此，在接受经导管主动脉瓣置换术（TAVR）治疗的严重主动脉瓣狭窄（AS）合并冠心病患者中，并未对计算得出的血流储备分数（FFR）进行验证。
在这项单中心研究中，我们前瞻性地纳入了 21 名患者（34 支血管），并在 TAVR 前进行了无硝酸甘油的 FFR 检测、TAVR 前有创瞬时无波比（iFR）测量和 TAVR 后的压力导丝 FFR 测量。FFR≤0.80 预测 TAVR 后 iFR≤0.80 的诊断准确性、敏感度、特异度、阳性预测值和阴性预测值分别为 82%、83%、82%、71%和 90%。受试者工作特征分析显示，FFR 的最佳截断值为 0.78，可用于预测 TAVR 后 FFR≤0.80，曲线下面积（AUC）为 0.84；而 TAVR 前 iFR 的最佳截断值为 0.89，AUC 为 0.86。
无硝酸甘油的 FFR 可能是一种有用的非侵入性成像方式，可用于评估严重 AS 患者冠状动脉病变的严重程度。
