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Feasibility and Comparison of Resting Full-Cycle Ratio and Computed Tomography Fractional Flow Reserve in Patients with Severe Aortic Valve Stenosis

Background: Computed tomography derived Fractional Flow Reserve (CT-FFR) has been shown to decrease the referral rate for invasive coronary angiography (ICA). The purpose of the study was to evaluate the diagnostic performance of CT-FFR compared to hyperemia-free index Resting Full-cycle Ratio (RFR)...

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Autores principales: Wienemann, Hendrik, Langenbach, Marcel C., Mauri, Victor, Banazadeh, Maryam, Klein, Konstantin, Hohmann, Christopher, Lee, Samuel, Breidert, Isabel, Hof, Alexander, Eghbalzadeh, Kaveh, Kuhn, Elmar, Halbach, Marcel, Maintz, David, Baldus, Stephan, Bunck, Alexander, Adam, Matti
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9030550/
https://www.ncbi.nlm.nih.gov/pubmed/35448092
http://dx.doi.org/10.3390/jcdd9040116
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author Wienemann, Hendrik
Langenbach, Marcel C.
Mauri, Victor
Banazadeh, Maryam
Klein, Konstantin
Hohmann, Christopher
Lee, Samuel
Breidert, Isabel
Hof, Alexander
Eghbalzadeh, Kaveh
Kuhn, Elmar
Halbach, Marcel
Maintz, David
Baldus, Stephan
Bunck, Alexander
Adam, Matti
author_facet Wienemann, Hendrik
Langenbach, Marcel C.
Mauri, Victor
Banazadeh, Maryam
Klein, Konstantin
Hohmann, Christopher
Lee, Samuel
Breidert, Isabel
Hof, Alexander
Eghbalzadeh, Kaveh
Kuhn, Elmar
Halbach, Marcel
Maintz, David
Baldus, Stephan
Bunck, Alexander
Adam, Matti
author_sort Wienemann, Hendrik
collection PubMed
description Background: Computed tomography derived Fractional Flow Reserve (CT-FFR) has been shown to decrease the referral rate for invasive coronary angiography (ICA). The purpose of the study was to evaluate the diagnostic performance of CT-FFR compared to hyperemia-free index Resting Full-cycle Ratio (RFR) in patients with relevant aortic stenosis (AS) and intermediate coronary stenosis. Methods: 41 patients with 46 coronary lesions underwent ICA with quantitative coronary angiography (QCA), pressure wire assessment and routine pre-transcatheter aortic valve replacement (TAVR) computed tomography (CT). CT-FFR analysis was performed using prototype on-site software. Results: RFR showed a significant correlation with CT-FFR (Pearson’s correlation, r = 0.632, p < 0.001). On a per-lesion basis, diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of CT-FFR were 82.6% (95% CI 68.6–92.2), 69.6% (95% CI 47.1–86.8), 95.7% (95% CI  78.1–99.9), 94.1% (95% CI 69.8–99.1), and 75.9% (95% CI 62.7–85.4), respectively. The optimal cutoff value of the CT-FFR for RFR ≤ 0.89 prediction was 0.815. The area under the receiver curve showed a larger area under the curve for CT-FFR (0.87; 95% CI 0.75–0.98) compared with CTA stenosis of ≥50% (0.54, 95% CI 0.38–0.71), CTA ≥ 70% (0.72, 95% CI 0.57–0.87) and QCA ≥ 50% (0.67, 95% CI 0.52–0.83). Conclusions: CT-FFR assessed by routine pre-TAVR CT is safe and feasible and shows a significant correlation with RFR in patients with AS. CT-FFR is superior to QCA ≥ 50%, CT ≥ 50% and CT ≥ 70% in assessing the hemodynamic relevance of intermediate coronary lesions. Thus, CT-FFR has the potential to guide revascularization in patients with AS.
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spelling pubmed-90305502022-04-23 Feasibility and Comparison of Resting Full-Cycle Ratio and Computed Tomography Fractional Flow Reserve in Patients with Severe Aortic Valve Stenosis Wienemann, Hendrik Langenbach, Marcel C. Mauri, Victor Banazadeh, Maryam Klein, Konstantin Hohmann, Christopher Lee, Samuel Breidert, Isabel Hof, Alexander Eghbalzadeh, Kaveh Kuhn, Elmar Halbach, Marcel Maintz, David Baldus, Stephan Bunck, Alexander Adam, Matti J Cardiovasc Dev Dis Article Background: Computed tomography derived Fractional Flow Reserve (CT-FFR) has been shown to decrease the referral rate for invasive coronary angiography (ICA). The purpose of the study was to evaluate the diagnostic performance of CT-FFR compared to hyperemia-free index Resting Full-cycle Ratio (RFR) in patients with relevant aortic stenosis (AS) and intermediate coronary stenosis. Methods: 41 patients with 46 coronary lesions underwent ICA with quantitative coronary angiography (QCA), pressure wire assessment and routine pre-transcatheter aortic valve replacement (TAVR) computed tomography (CT). CT-FFR analysis was performed using prototype on-site software. Results: RFR showed a significant correlation with CT-FFR (Pearson’s correlation, r = 0.632, p < 0.001). On a per-lesion basis, diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of CT-FFR were 82.6% (95% CI 68.6–92.2), 69.6% (95% CI 47.1–86.8), 95.7% (95% CI  78.1–99.9), 94.1% (95% CI 69.8–99.1), and 75.9% (95% CI 62.7–85.4), respectively. The optimal cutoff value of the CT-FFR for RFR ≤ 0.89 prediction was 0.815. The area under the receiver curve showed a larger area under the curve for CT-FFR (0.87; 95% CI 0.75–0.98) compared with CTA stenosis of ≥50% (0.54, 95% CI 0.38–0.71), CTA ≥ 70% (0.72, 95% CI 0.57–0.87) and QCA ≥ 50% (0.67, 95% CI 0.52–0.83). Conclusions: CT-FFR assessed by routine pre-TAVR CT is safe and feasible and shows a significant correlation with RFR in patients with AS. CT-FFR is superior to QCA ≥ 50%, CT ≥ 50% and CT ≥ 70% in assessing the hemodynamic relevance of intermediate coronary lesions. Thus, CT-FFR has the potential to guide revascularization in patients with AS. MDPI 2022-04-14 /pmc/articles/PMC9030550/ /pubmed/35448092 http://dx.doi.org/10.3390/jcdd9040116 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Wienemann, Hendrik
Langenbach, Marcel C.
Mauri, Victor
Banazadeh, Maryam
Klein, Konstantin
Hohmann, Christopher
Lee, Samuel
Breidert, Isabel
Hof, Alexander
Eghbalzadeh, Kaveh
Kuhn, Elmar
Halbach, Marcel
Maintz, David
Baldus, Stephan
Bunck, Alexander
Adam, Matti
Feasibility and Comparison of Resting Full-Cycle Ratio and Computed Tomography Fractional Flow Reserve in Patients with Severe Aortic Valve Stenosis
title Feasibility and Comparison of Resting Full-Cycle Ratio and Computed Tomography Fractional Flow Reserve in Patients with Severe Aortic Valve Stenosis
title_full Feasibility and Comparison of Resting Full-Cycle Ratio and Computed Tomography Fractional Flow Reserve in Patients with Severe Aortic Valve Stenosis
title_fullStr Feasibility and Comparison of Resting Full-Cycle Ratio and Computed Tomography Fractional Flow Reserve in Patients with Severe Aortic Valve Stenosis
title_full_unstemmed Feasibility and Comparison of Resting Full-Cycle Ratio and Computed Tomography Fractional Flow Reserve in Patients with Severe Aortic Valve Stenosis
title_short Feasibility and Comparison of Resting Full-Cycle Ratio and Computed Tomography Fractional Flow Reserve in Patients with Severe Aortic Valve Stenosis
title_sort feasibility and comparison of resting full-cycle ratio and computed tomography fractional flow reserve in patients with severe aortic valve stenosis
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9030550/
https://www.ncbi.nlm.nih.gov/pubmed/35448092
http://dx.doi.org/10.3390/jcdd9040116
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