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. 2023 Aug 30:10:1188644.
doi: 10.3389/fcvm.2023.1188644. eCollection 2023.

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

Pierluigi Demola  1 , Iginio Colaiori  1 , Davide Bosi  1 , Sergio Musto D'Amore  1 , Marco Vitolo  2   3 , Giorgio Benatti  4 , Luigi Vignali  4 , Iacopo Tadonio  4 , Davide Gabbieri  5 , Luciano Losi  6 , Paolo Magnavacchi  7 , Fabio Alfredo Sgura  2 , Giuseppe Boriani  2 , Vincenzo Guiducci  1
Affiliations

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

Pierluigi Demola et al. Front Cardiovasc Med. .

Abstract

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.

Keywords: aortic stenosis; coronary artery disease; coronary physiology; fractional flow reserve; quantitative flow ratio (QFR).

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Conflict of interest statement

GB: small speaker fee from Bayer, Boehringer Ingelheim, Boston, Daiichi- Sankyo and Janssen outside the present article. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Central illustration. QFR, quantitative flow ratio; TAVI, transcatheter aortic valve implantation, TIA, transient ischemic attack; THV, transcatheter heart valve.
Figure 2
Figure 2
Kaplan Meyers curves for all cause of mortality. Red line represents QFR+ cohort trend during the follow up period, blue line represents QFR- cohort during the follow up period. the median follow-up was 1,005 days [IQR 582-2218]. QFR, quantitative flow ratio.
Figure 3
Figure 3
Kaplan Meyers curves for secondary outcome (composite of all-cause mortality, cardiovascular mortality, stroke/transient ischemic attack (TIA), myocardial infarction (MI), and any hospitalization after TAVI). Red line represents QFR+ cohort trend during the follow up period, blue line represents QFR- cohort during the follow up period. The median follow-up was 1,005 days [IQR 582-2218]. QFR, quantitative flow ratio; TAVI, transcatheter aortic valve implantation, TIA, transient ischemic attack.
See this image and copyright information in PMC

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