Khoo John King, Sellers Stephanie, Fairbairn Timothy, Polsani Venkateshwar, Liu Shizhen, Yong Gerald, Shetty Sharad, Corrigan Frank, Ko Brian, Vucic Esad, Fitzgibbons Timothy P, Kakouros Nikolaos, Blanke Philipp, Sathananthan Janarthanan, Webb John, Wood David, Leipsic Jonathon, Ihdayhid Abdul Rahman
Department of Radiology, St. Paul's Hospital, University of British Columbia, Vancouver, Canada.
Department of Cardiology, Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom.
J Soc Cardiovasc Angiogr Interv. 2024 Mar 26;3(3Part B):101293. doi: 10.1016/j.jscai.2023.101293. eCollection 2024 Mar.
Coronary artery disease (CAD) in patients with severe aortic stenosis (AS) is common and may be associated with worse outcomes. Computed tomography coronary angiography (CTCA) and fractional flow reserve derived from computed tomography (FFR) are tools for comprehensive coronary assessment. The utility and safety of CTCA and FFR in the work-up for transcatheter aortic valve replacement (TAVR) is not established, especially in an evolving landscape that involves younger TAVR patients. The FUTURE-AS Registry will assess the utility and safety of cardiac-optimized CTCA and FFR to evaluate CAD and guide referral for downstream invasive coronary angiography (ICA) in patients with severe AS being considered for TAVR.
FUTURE-AS is an international, prospective, multicenter registry of patients with severe AS referred for TAVR being assessed for CAD with CTCA and FFR. The primary end point is the per-patient sensitivity and negative predictive value of CTCA and FFR for identifying anatomical and physiologically significant CAD compared to ICA and invasive FFR. The safety end point is the incidence of symptomatic hypotension or bradycardia requiring intervention following the administration of nitroglycerin or β-blocker medications. Feasibility end points include the incidence of noninterpretable CTCA scans and CTCA scans not adequate for FFR analysis. Other utility end points include specificity, positive predictive value, and accuracy of CTCA and FFR. Lastly, the potential of a CTCA and FFR guided strategy to defer pre-TAVR ICA will be assessed.
FUTURE-AS will characterize the utility, safety, and feasibility of CTCA and FFR for coronary assessment pre-TAVR.
重度主动脉瓣狭窄（AS）患者的冠状动脉疾病（CAD）很常见，且可能与更差的预后相关。计算机断层扫描冠状动脉造影（CTCA）和基于计算机断层扫描的血流储备分数（FFR）是用于全面冠状动脉评估的工具。CTCA和FFR在经导管主动脉瓣置换术（TAVR）检查中的效用和安全性尚未确定，尤其是在涉及更年轻TAVR患者的不断变化的情况下。FUTURE-AS注册研究将评估心脏优化的CTCA和FFR在评估重度AS且考虑行TAVR患者的CAD以及指导下游有创冠状动脉造影（ICA）转诊方面的效用和安全性。
FUTURE-AS是一项国际性、前瞻性、多中心注册研究，纳入因TAVR而转诊且正在接受CTCA和FFR评估CAD的重度AS患者。主要终点是与ICA和有创FFR相比，CTCA和FFR识别解剖学和生理学上有意义的CAD的患者个体敏感性和阴性预测值。安全终点是给予硝酸甘油或β受体阻滞剂药物后需要干预的症状性低血压或心动过缓的发生率。可行性终点包括无法解读的CTCA扫描发生率和不适用于FFR分析的CTCA扫描发生率。其他效用终点包括CTCA和FFR的特异性、阳性预测值和准确性。最后，将评估CTCA和FFR指导策略推迟TAVR术前ICA的可能性。
FUTURE-AS将描述CTCA和FFR在TAVR术前冠状动脉评估中的效用、安全性和可行性。
