Bellouche Yahia, Abdelli Sirine, Hannachi Sinda, Benic Clement, Le Ven Florent, Didier Romain
Cardiology Department, Brest University Hospital (CHRU Brest), 29200 Brest, France.
Medicine Faculty, Western Brittany University (UBO), 29200 Brest, France.
Bioengineering (Basel). 2025 Mar 26;12(4):339. doi: 10.3390/bioengineering12040339.
Aortic stenosis (AS) frequently coexists with coronary artery disease (CAD), complicating revascularization decisions. The use of coronary physiology indices, such as the fractional flow reserve (FFR), instantaneous wave-free ratio (iFR), and coronary flow reserve (CFR), in AS patients remains debated, particularly after transcatheter aortic valve implantation (TAVI). In this study, we employ computational fluid dynamics (CFD) to evaluate coronary hemodynamics and assess changes in the wall shear stress (WSS) before and after TAVI. Our analysis demonstrates strong agreement between CFD-derived and invasive FFR measurements, confirming CFD's reliability as a non-invasive tool for coronary physiology assessment. Furthermore, our results show no significant changes in FFR (p=0.92), iFR (p=0.67), or CFR (p=0.34) post-TAVI, suggesting that these indices remain stable following aortic valve intervention. However, a significant reduction in high WSS exposure (59% to 40.8%, p<0.001) and the oscillatory shear index (OSI: 0.32 to 0.21, p<0.001) was observed, indicating improved hemodynamic stability. These findings suggest that coronary physiology indices remain reliable for revascularization guidance post-TAVI and highlight a potential beneficial effect of aortic stenosis treatment on plaque shear stress dynamics. Our study underscores the clinical utility of CFD modeling in CAD management, paving the way for further research into its prognostic implications.
主动脉瓣狭窄(AS)常与冠状动脉疾病(CAD)并存,这使得血运重建决策变得复杂。在AS患者中使用冠状动脉生理学指标,如血流储备分数(FFR)、瞬时无波比值(iFR)和冠状动脉血流储备(CFR),仍存在争议,尤其是在经导管主动脉瓣植入术(TAVI)之后。在本研究中,我们采用计算流体动力学(CFD)来评估冠状动脉血流动力学,并评估TAVI前后壁面剪应力(WSS)的变化。我们的分析表明,CFD得出的测量值与有创FFR测量值高度一致,证实了CFD作为一种用于冠状动脉生理学评估的非侵入性工具的可靠性。此外,我们的结果显示,TAVI后FFR(p = 0.92)、iFR(p = 0.67)或CFR(p = 0.34)没有显著变化,这表明在主动脉瓣干预后这些指标保持稳定。然而,观察到高WSS暴露(从59%降至40.8%,p < 0.001)和振荡剪切指数(OSI:从0.32降至0.21,p < 0.001)显著降低,表明血流动力学稳定性得到改善。这些发现表明,冠状动脉生理学指标在TAVI后对血运重建指导仍然可靠,并突出了主动脉瓣狭窄治疗对斑块剪切应力动态的潜在有益影响。我们的研究强调了CFD建模在CAD管理中的临床实用性,为进一步研究其预后意义铺平了道路。