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Quantitative flow ratio-based outcomes in patients undergoing transcatheter aortic valve implantation quaestio study

BACKGROUND: Coronary artery disease (CAD) is common in patients with aortic valve stenosis (AS) ranging from 60% to 80%. The clinical and prognostic role of coronary artery lesions in patients undergoing Transcatheter Aortic Valve Implantation (TAVI) remains unclear. The aim of the present observati...

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Autores principales: Demola, Pierluigi, Colaiori, Iginio, Bosi, Davide, Musto D’Amore, Sergio, Vitolo, Marco, Benatti, Giorgio, Vignali, Luigi, Tadonio, Iacopo, Gabbieri, Davide, Losi, Luciano, Magnavacchi, Paolo, Sgura, Fabio Alfredo, Boriani, Giuseppe, Guiducci, Vincenzo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10499393/
https://www.ncbi.nlm.nih.gov/pubmed/37711555
http://dx.doi.org/10.3389/fcvm.2023.1188644
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author Demola, Pierluigi
Colaiori, Iginio
Bosi, Davide
Musto D’Amore, Sergio
Vitolo, Marco
Benatti, Giorgio
Vignali, Luigi
Tadonio, Iacopo
Gabbieri, Davide
Losi, Luciano
Magnavacchi, Paolo
Sgura, Fabio Alfredo
Boriani, Giuseppe
Guiducci, Vincenzo
author_facet Demola, Pierluigi
Colaiori, Iginio
Bosi, Davide
Musto D’Amore, Sergio
Vitolo, Marco
Benatti, Giorgio
Vignali, Luigi
Tadonio, Iacopo
Gabbieri, Davide
Losi, Luciano
Magnavacchi, Paolo
Sgura, Fabio Alfredo
Boriani, Giuseppe
Guiducci, Vincenzo
author_sort Demola, Pierluigi
collection PubMed
description BACKGROUND: Coronary artery disease (CAD) is common in patients with aortic valve stenosis (AS) ranging from 60% to 80%. The clinical and prognostic role of coronary artery lesions in patients undergoing Transcatheter Aortic Valve Implantation (TAVI) remains unclear. The aim of the present observational study was to estimate long-term clinical outcomes by Quantitative Flow Ratio (QFR) characterization of CAD in a well-represented cohort of patients affected by severe AS treated by TAVI. METHODS: A total of 439 invasive coronary angiographies of patients deemed eligible for TAVI by local Heart Teams with symptomatic severe AS were retrospectively screened for QFR analysis. The primary endpoint of the study was all-cause mortality. The secondary endpoint was a composite of cardiovascular mortality, stroke/transient ischemic attack (TIA), acute myocardial infarction (AMI), and any hospitalization after TAVI. RESULTS: After exclusion of patients with no follow-up data, coronary angiography not feasible for QFR analysis and previous surgical myocardial revascularization (CABG) 48/239 (20.1%) patients had a QFR value lower or equal to 0.80 (QFR + value), while the remaining 191/239 (79.9%) did not present any vessel with a QFR positive value. In the adjusted Cox regression analysis, patients with positive QFR were independently associated with an increased risk of all-casual mortality (Model 1, HR 3.47, 95% CI, 2.35−5.12; Model 2, HR 5.01, 95% CI, 3.17−7.90). In the adjusted covariate analysis, QFR+ involving LAD (37/48, 77,1%) was associated with the higher risk of the composite outcome compared to patients without any positive value of QFR or non-LAD QFR positive value (11/48, 22.9%). CONCLUSIONS: Pre-TAVI QFR analysis can be used for a safe, simple, wireless functional assessment of CAD. QFR permits to identify patients at high risk of cardiovascular mortality or MACE, and it could be considered by local Heart Teams.
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spelling pubmed-104993932023-09-14 Quantitative flow ratio-based outcomes in patients undergoing transcatheter aortic valve implantation quaestio study Demola, Pierluigi Colaiori, Iginio Bosi, Davide Musto D’Amore, Sergio Vitolo, Marco Benatti, Giorgio Vignali, Luigi Tadonio, Iacopo Gabbieri, Davide Losi, Luciano Magnavacchi, Paolo Sgura, Fabio Alfredo Boriani, Giuseppe Guiducci, Vincenzo Front Cardiovasc Med Cardiovascular Medicine BACKGROUND: Coronary artery disease (CAD) is common in patients with aortic valve stenosis (AS) ranging from 60% to 80%. The clinical and prognostic role of coronary artery lesions in patients undergoing Transcatheter Aortic Valve Implantation (TAVI) remains unclear. The aim of the present observational study was to estimate long-term clinical outcomes by Quantitative Flow Ratio (QFR) characterization of CAD in a well-represented cohort of patients affected by severe AS treated by TAVI. METHODS: A total of 439 invasive coronary angiographies of patients deemed eligible for TAVI by local Heart Teams with symptomatic severe AS were retrospectively screened for QFR analysis. The primary endpoint of the study was all-cause mortality. The secondary endpoint was a composite of cardiovascular mortality, stroke/transient ischemic attack (TIA), acute myocardial infarction (AMI), and any hospitalization after TAVI. RESULTS: After exclusion of patients with no follow-up data, coronary angiography not feasible for QFR analysis and previous surgical myocardial revascularization (CABG) 48/239 (20.1%) patients had a QFR value lower or equal to 0.80 (QFR + value), while the remaining 191/239 (79.9%) did not present any vessel with a QFR positive value. In the adjusted Cox regression analysis, patients with positive QFR were independently associated with an increased risk of all-casual mortality (Model 1, HR 3.47, 95% CI, 2.35−5.12; Model 2, HR 5.01, 95% CI, 3.17−7.90). In the adjusted covariate analysis, QFR+ involving LAD (37/48, 77,1%) was associated with the higher risk of the composite outcome compared to patients without any positive value of QFR or non-LAD QFR positive value (11/48, 22.9%). CONCLUSIONS: Pre-TAVI QFR analysis can be used for a safe, simple, wireless functional assessment of CAD. QFR permits to identify patients at high risk of cardiovascular mortality or MACE, and it could be considered by local Heart Teams. Frontiers Media S.A. 2023-08-30 /pmc/articles/PMC10499393/ /pubmed/37711555 http://dx.doi.org/10.3389/fcvm.2023.1188644 Text en © 2023 Demola, Colaiori, Bosi, Musto D'Amore, Vitolo, Benatti, Vignali, Tadonio, Gabbieri, Losi, Magnavacchi, Sgura, Boriani and Guiducci. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) (https://creativecommons.org/licenses/by/4.0/) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Cardiovascular Medicine
Demola, Pierluigi
Colaiori, Iginio
Bosi, Davide
Musto D’Amore, Sergio
Vitolo, Marco
Benatti, Giorgio
Vignali, Luigi
Tadonio, Iacopo
Gabbieri, Davide
Losi, Luciano
Magnavacchi, Paolo
Sgura, Fabio Alfredo
Boriani, Giuseppe
Guiducci, Vincenzo
Quantitative flow ratio-based outcomes in patients undergoing transcatheter aortic valve implantation quaestio study
title Quantitative flow ratio-based outcomes in patients undergoing transcatheter aortic valve implantation quaestio study
title_full Quantitative flow ratio-based outcomes in patients undergoing transcatheter aortic valve implantation quaestio study
title_fullStr Quantitative flow ratio-based outcomes in patients undergoing transcatheter aortic valve implantation quaestio study
title_full_unstemmed Quantitative flow ratio-based outcomes in patients undergoing transcatheter aortic valve implantation quaestio study
title_short Quantitative flow ratio-based outcomes in patients undergoing transcatheter aortic valve implantation quaestio study
title_sort quantitative flow ratio-based outcomes in patients undergoing transcatheter aortic valve implantation quaestio study
topic Cardiovascular Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10499393/
https://www.ncbi.nlm.nih.gov/pubmed/37711555
http://dx.doi.org/10.3389/fcvm.2023.1188644
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