Fang Yi, Qiu Miaohan, Sun Yu, Guo Ran, Yu Bo, Liu Bin, Sun Yingxian, Tong Qian, Liu Jihong, Pang Wenyue, Luan Bo, Wang Bin, Wang Geng, Li Yang, Liang Zhenyang, Xu Kai, Han Yaling
Laboratory of Frigid Zone Cardiovascular Disease, Cardiovascular Research Institute, Department of Cardiology, General Hospital of Northern Theater Command, No. 83 Wenhua Road, Shenhe Distract, Shenyang, 110016, China.
Department of Radiology, General Hospital of Northern Theater Command, No. 83 Wenhua Road, Shenhe Distract, Shenyang, 110016, China.
Sci Rep. 2025 Sep 1;15(1):32234. doi: 10.1038/s41598-025-17951-w.
To assess the value of computed tomography angiography (CTA)-derived fractional flow reserve (CT-FFR) and high-risk plaque characteristics (HRPC) in the prediction of prognosis in patients with concomitant aortic stenosis (AS) and coronary artery disease (CAD) after transcatheter aortic valve replacement (TAVR). The study was a post hoc analysis from a multicenter TAVR registry. Patients with AS and obstructive CAD who underwent successful TAVR treatment were enrolled. The CT-FFR and HRPC were measured in coronary vessels with ≥ 50% stenosis lesions. The patients were then grouped according to CT-FFR (≤ 0.8 vs. >0.8) and HRPC (Yes vs. No) criteria. The primary outcome was major adverse cardiovascular events (MACE), a composite of cardiac death, nonfatal myocardial infarction, and ischemia-driven revascularization. The multivariable Cox proportional regression was used to identify independent predictors of MACE. To assess the combined prognostic value of CT-FFR and HRPC to OPT-CAD risk, receiver operating characteristic curves were used and the area under the curve (AUC) was determined. A total of 213 patients were enrolled. The mean age was 74.34 years and 125 (58.4%) were male. The patients with lower CT-FFR (≤ 0.8) had a higher rate of MACE compared with those with CT-FFR > 0.8 (11.9% vs. 2.3%, P = 0.011). However, there was no significant difference in MACE incidence (9.0% vs. 5.3%, P = 0.38) between patients with and without HRPC, respectively. The Cox regression model revealed that advanced age (hazard ratio [HR] 1.07, 95% confidence interval [CI] 1.003-1.15, P = 0.04), elevated NT-proBNP levels (HR 1.004, 95% CI 1.00-1.01, P = 0.046), and higher CT-FFR (HR 0.78, 95% CI 0.62-0.97, P = 0.03) were independent predictors of MACE. The optimal threshold value for predicting MACE using CT-FFR was determined to be 0.79. The performance in predicting MACE using the OPT-CAD score model was enhanced when both CT-FFR and HRPC were incorporated into the model [AUC 0.63 (0.49-0.76) vs. 0.74 (0.63-0.84), P = 0.04]. Pre-procedure CT-FFR was an independent predictor of MACE in patients with concomitant AS and CAD after TAVR.
评估计算机断层扫描血管造影（CTA）衍生的血流储备分数（CT-FFR）和高危斑块特征（HRPC）对经导管主动脉瓣置换术（TAVR）后合并主动脉瓣狭窄（AS）和冠状动脉疾病（CAD）患者预后的预测价值。该研究是一项来自多中心TAVR注册研究的事后分析。纳入接受成功TAVR治疗的AS和阻塞性CAD患者。在狭窄病变≥50%的冠状动脉血管中测量CT-FFR和HRPC。然后根据CT-FFR（≤0.8 vs. >0.8）和HRPC（是 vs. 否）标准对患者进行分组。主要结局是主要不良心血管事件（MACE），包括心源性死亡、非致命性心肌梗死和缺血驱动的血运重建的复合事件。使用多变量Cox比例回归来确定MACE的独立预测因素。为了评估CT-FFR和HRPC对优化CAD风险的联合预后价值，使用了受试者工作特征曲线并确定曲线下面积（AUC）。共纳入213例患者。平均年龄为74.34岁，125例（58.4%）为男性。CT-FFR较低（≤0.8）的患者MACE发生率高于CT-FFR >0.8的患者（11.9% vs. 2.3%，P = 0.011）。然而，有HRPC和无HRPC的患者MACE发生率分别为9.0%和5.3%，差异无统计学意义（P = 0.38）。Cox回归模型显示，高龄（风险比[HR] 1.07，95%置信区间[CI] 1.003 - 1.15，P = 0.04）、NT-proBNP水平升高（HR 1.004，95% CI 1.00 - 1.01，P = 0.046）和较高的CT-FFR（HR 0.78，95% CI 0.62 - 0.97，P = 0.03）是MACE的独立预测因素。使用CT-FFR预测MACE的最佳阈值确定为0.79。当将CT-FFR和HRPC都纳入模型时，使用优化CAD评分模型预测MACE的性能得到增强[AUC 0.（0.49 - 0.76） vs. 0.74（0.63 - 0.84），P = 0.04]。术前CT-FFR是TAVR后合并AS和CAD患者MACE的独立预测因素。
