- Email: [email protected]
Pa) compared with fractional flow reserve (FFR). A 10-year follow-up study after deferral of revascularization
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 68, NO. 18, SUPPL B, 2016
iFR was measured (RESOLVE). FFR/iFR discordance was also identified in the IDEAL study in which CFR was determined in addition to FFR and iFR. Median CFR values were compared between the discordant groups to determine if increasing flow during hyperemia explained the FFR+/iFR- discordance. RESULTS From RESOLVE, the prevalence of FFR/iFR discordance was 198/1041 (19.0%), occurring most frequently in the left anterior descending artery (p¼0.047). From IDEAL, the FFR/iFR discordance rate was 54/366 (14.8%). From IDEAL, median CFR was 1.52 (1.16-1.67) in the FFR+ group (n¼129) vs.1.42 (1.15-1.88) in the iFR+ group (n¼142; p¼0.20). In the FFR- (n¼237) and the iFR- (n¼224) groups, the CFR was 2.20 (1.72-2.79) vs. 2.45 (1.90-2.97), respectively (p¼0.07). However, in discordant cases, median CFR was 2.47 (1.98-2.94) with FFR+ and iFR- (n¼19) and 1.44 (1.27-1.86) with FFR- and iFR+ (n¼32; p<0.0001), indicating a closer correlation between CFR and iFR than with CFR and FFR. There were no significant differences in patient or stenosis characteristics between the discordant groups (p>0.05 for all).
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compared fractional myocardial mass (FMM) with multiple angiographic scores. METHODS In this multicenter prospective registry, a total of 453 patients who underwent CCTA followed by invasive coronary angiography were enrolled. Syntax, Gensini, BARI jeopardy, Duke Jeopardy, and APPROACH scores were compared with FMM subtended by vessels with diameter stenosis (DS) 70% (FMM%-70) or 50% (FMM%-50). RESULTS All angiographic scores showed significant correlation each other and also with FMM. Angiographic scores reflecting the amount of jeopardized myocardium (APPROACH and Duke Jeopardy) showed higher correlation (r >0.9) compared with anatomy-based scores (Syntax, Gensini, BARI jeopardy) (r y 0.7).
CONCLUSION Discordance between FFR and iFR occurs in a substantial proportion of cases, nearly one in five. Median CFR is normal (>2.0) in FFR+/iFR- cases and is abnormal (<2.0) in FFR-/iFR+ cases. The inverse relationship between FFR and CFR suggests that hyperemia may confound the identification of flow limiting stenoses with pressure-only indices.
CONCLUSION FMM showed good correlation with angiographic scores which reflects the extent of jeopardized myocardium and prognosis.
CATEGORIES IMAGING: FFR and Physiologic Lesion Assessment
TCT-515 Prognostic implications of instantaneous wave-free ratio (iFR) and resting distal-to-aortic pressure ratio (Pd/Pa) compared with fractional flow reserve (FFR). A 10-year follow-up study after deferral of revascularization
TCT-514 Comparison of angiographic scores and fractional myocardial mass: Use of fractional myocardial mass for comprehensive evaluation of coronary artery disease Hyung Yoon Kim,1 Joon-Hyung Doh,2 Hong-Seok Lim,3 Myeong-Ho Yoon,4 Doo Kyoung Kang,5 Chang-Wook Nam,6 Bon-Kwon Koo,7 Eun Kyoung Kim,8 Seung-Jea Tahk,9 Eun-Seok Shin,10 Sung Mok Kim,11 Yeonhyeon Choe,12 Jin-Ho Choi13 1 Samsung Medical Center, Seoul, Korea, Republic of; 2Inje University Ilsan Paik Hospital; 3Ajou University Medical Center, Suwon, Korea, Republic of; 4Unknown; 5Department of Radiology, Ajou University School of Medicine, Suwon, Korea; 6Keimyung University Dongsan Medical Center, Daegu, Korea, Republic of; 7Seoul National University Hospital, Seoul, Korea, Republic of; 8Turgut Ozal University, Department of Biochemistry; 9Ajou University Medical Center, Suwon, Korea, Republic of; 10Ulsan University Hospital, Ulsan, Korea, Republic of; 11DDepart of Radiology, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; 12Depart of Radiology, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; 13Samsung Medical Center, Seoul, Korea, Republic of BACKGROUND FMM is a vessel-specific myocardial mass derived from coronary computed tomography angiography (CCTA) and enables quantitative assessment of potentially ischemic myocardial mass. We compared FMM with semi-quantitative angiographic scores which have been developed to evaluate the risk and burden of myocardial ischemia but have heterogeneous background. We
CATEGORIES IMAGING: FFR and Physiologic Lesion Assessment
Tim van de Hoef,1 Gilbert Wijntjens,2 Martijn Meuwissen,3 Mauro Echavarria Pinto,4 Martijn van Lavieren,5 Karel Koch,6 Steven Chamuleau,7 Michiel Voskuil,8 Robert de Winter,9 Jan Tijssen,10 Jan Piek11 1 Academic Medical Center - University of Amsterdam, Amsterdam, Netherlands; 2Academisch Medisch Centrum, Amsterdam, Netherlands; 3Breda Amphia Ziekenhuis, Breda, Netherlands; 4Hospital General ISSSTE, Queretaro, Querétaro, Mexico; 5Academic Medical Center- University of Amster, Amsterdam, Netherlands; 6Academic Medical Center - University of Amsterdam, Amsterdam, Netherlands; 7 UMCU, Utrecht, Netherlands; 8UMC Utrecht; 9Academisch Medisch Centrum, Amsterdam, Netherlands; 10AMC-UVA, Naarden, Netherlands; 11University of Amsterdam, Amsterdam, Netherlands BACKGROUND iFR and Pd/Pa are novel indices introduced to enhance adoption of physiology-guided revascularization. Their absolute agreement with FFR is 80%, but both indices agree better with coronary flow reserve (CFR) than FFR. Since CFR is a critical determinant of myocardial ischemia and clinical outcome, we hypothesized that this agreement with CFR results in dominant prognostic value of iFR and Pd/Pa over FFR. METHODS Between 4-1997 and 9-2006, we studied 154 stenoses (154 patients), in which revascularization was deferred, with intracoronary pressure and flow measurements. Follow-up (median 11.8 years) was performed to study the occurrence of adverse events: a composite of
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cardiac death, myocardial infarction and target vessel revascularization (MACE). RESULTS CFR had dominant prognostic value (standardized HR:0.59 (95%CI: 0.43–0.80)), but the association of Pd/Pa with long-term MACE was similar to that of FFR (FFR sHR:0.77 (95%CI: 0.61–0.98); Pd/Pa sHR:0.80 (95%CI: 0.67–0.96)). iFR was available in 44 stenoses, and was also significantly associated with long-term MACE (iFR sHR:0.66 (95%CI: 0.46–0.95)). When Pd/Pa or iFR disagreed with FFR, normal Pd/Pa or iFR was generally associated with normal CFR values and had favorable clinical outcome, whereas abnormal Pd/Pa or iFR was generally associated with CFR values around the ischemic cut-off value and had impaired clinical outcome.
TCT-517 Fractional flow reserve assessment of coronary artery disease in patients Undergoing TAVI. Gabriele Pesarini,1 Roberto Scarsini,2 Carlo Zivelonghi,3 Anna Piccoli,4 Alessia Gambaro,5 Valeria Ferrero,6 Corrado Vassanelli,7 Flavio Ribichini8 1 Ospedale Civile Maggiore Borgo Trento, Verona, Italy; 2University of Verona; 3Azienda ospedaliera universitaria di Verona, Verona, Venice, Italy; 4Athens Medical School, Hippokration Hospital; 5Azienda ospedaliera Verona, Verona, Venice, Italy; 6Unknown, Cuneo, Italy; 7 University of Verona, Verona, Venice, Italy; 8Università di Verona, Verona, Italy BACKGROUND Aortic valve stenosis (AVS) may influence fractional flow reserve (FFR) of concomitant coronary artery disease (CAD) by causing hypertrophy and reducing the vasodilatory reserve of the coronary circulation. The hypothesis was made that TAVI, changing ventricular function by eliminating valvular obstruction, can improve coronary blood flow and then influence the functional assessment of coronary lesions. We sought to investigate if FFR values might change after valve replacement.
CONCLUSION The prognostic value of Pd/Pa and iFR is at least equivalent to FFR. When Pd/Pa or iFR disagrees with FFR, the resting index dominantly determines long-term MACE, likely through better agreement with CFR. CATEGORIES IMAGING: FFR and Physiologic Lesion Assessment TCT-516 Instantaneous-wave Free Ratio and Fractional Flow Reserve Comparison in Patients with and Without Severe Aortic Valve Stenosis. Roberto Scarsini,1 Gabriele Pesarini,2 Carlo Zivelonghi,3 Anna Piccoli,4 Alessia Gambaro,5 Corrado Vassanelli,6 Flavio Ribichini7 1 University of Verona; 2Ospedale Civile Maggiore Borgo Trento, Verona, Italy; 3Azienda ospedaliera universitaria di Verona, Verona, Venice, Italy; 4Athens Medical School, Hippokration Hospital; 5Azienda ospedaliera Verona, Verona, Venice, Italy; 6University of Verona, Verona, Venice, Italy; 7Università di Verona, Verona, Italy BACKGROUND Fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) have not been extensively investigated in patients with severe aortic valve stenosis(AVS) and concomitant coronary artery disease(CAD). The aim of this study was to compare FFR and iFR measurements in patients with severe symptomatic AVS and in patients without AVS, and to correlate these findings with angiographic quantitative coronary analysis (QCA). METHODS FFR and iFR were prospectively measured in the major coronary artery branches of patients undergoing diagnostic coronary angiography as part of the workout for TAVI. Quantitative Coronary Angiography(QCA) was blinded of the FFR-iFR results. These were compared with a matched control group of CAD patients without any valve disease. An FFR value 0.80 was considered pathologic while an FFR value >0.80 was considered ‘negative’. ROC curve analysis was performed in order to find the diagnostic accuracy and the optimal diagnostic cut-off value of iFR in predicting postive FFR (0.80) in the AVS and in the CAD population. RESULTS One-hundred-sixty-six patients (54 AVS and 112 CAD) with 393 lesions (131 AVS and 262 CAD) were enrolled. Correlation between FFR-iFR and QCA parameters was modest but remained constant in patients with AVS. FFR-iFR correlation was maintained in AVS compared with CAD patients, and the iFR accuracy for predicting FFR0.8 was similar between the two groups (AUC:0.94 vs 0.96, p¼0.45). Using the current cutoff point of iFR0.9 for predicting a positive FFR, the false positive rate was 22.6% in the AVS group compared to 16.5% in the CAD group (p¼0.27), with a positive predictive value of 41% and 71.7% for AVS and CAD patients respectively. At ROC curve analysis the best cut-off of iFR predicting FFR0.8 was lower in patients with AVS compared with CAD patients: 0.84 (J¼0.82) vs 0.88 (J¼0.81). CONCLUSION AVS may influence functional assessment of concomitant CAD. FFR-iFR correlation in AVS resulted poorer compared with CAD patients. The 0.90 iFR cut-off value to match 0.80 FFR cut-off may defer in AVS patients and deserves further comparative studies. CATEGORIES IMAGING: FFR and Physiologic Lesion Assessment
METHODS In this prospective, observational study, FFR measurements were attempted in the three major epicardial arteries before TAVI and immediately after the trans-catheter valve implantation maintaining similar hemodynamic conditions. The functional relevance of 120 coronary lesions was assessed by FFR in 47 patients with severe AVS. Comparison of variables before and after TAVI was performed using a paired Student’s t-test. RESULTS No significant overall change in FFR values was found before and after TAVI (0.880.10 vs (0.890.12, p¼0.65). Positive FFR values at baseline (0.8), worsened after TAVI: 0.710.11 vs 0.650.13, p¼0.001. Conversely, negative FFR values at baseline improved: 0.910.05 vs 0.930.07, p¼0.01. Similarly, FFR values in arteries with mild lesions (%DS<50) improved after TAVI (0.920.06 vs 0.930.07, p¼0.03), while lesions with %DS>50 tended toward worsening (0.820.12 vs 0.800.16, p¼0.17). Functional FFR variations after TAVI changed the indication to treat the coronary stenosis in 7 out of 120 (5.8%) of lesions, (15% of patients). CONCLUSION Coronary hemodynamics are influenced by AVS removal. Nevertheless, FFR variations after TAVI are minor and crossed the diagnostic cut-off of 0.8 in a small number of patients after valve replacement. Borderline coronary lesions might become functionally significant after valve replacement, although FFR-guided interventions were infrequent even in patients with angiographically significant lesions. CATEGORIES IMAGING: FFR and Physiologic Lesion Assessment
TCT-518 The Interaction between Aortic and Coronary Pressures for Fractional Flow Reserve Value in Patients with an Intermediate Coronary Artery Stenosis Hiroyuki Okura,1 Yuhei Kobayashi,2 Yoji Neishi,3 Tomitaka Higa,4 Yukari Kobayashi,5 Shiro Uemura,6 Kiyoshi Yoshida7 1 Nara Medical University, Kashihara, Japan; 2Stanford University, Stanford, California, United States; 3Kawasaki Medical School, Kurashiki, Japan; 4Kawasaki Mecical School; 5Stanford University, Stanford, California, United States; 6Kawasaki Medical School, Kurashiki, Japan; 7The Sakakibara Heart Institute of Okayama BACKGROUND Fractional flow reserve (FFR) has been used as an index unaffectd by hemodynamic alteration. However, there is a theoretical concern that the further decrement of aortic pressure may result in artificially elevated FFR value. The aim of this study was to investigate relationship between alterations in aortic blood pressure and changes in FFR after adjunctive intracoronary nicorandil. METHODS A total of 183 intermediate native coronary artery lesions from 112 patients were prospectively enrolled to this study. The mean aortic pressure (Pa), the mean distal coronary pressure (Pd), and FFR were measured during intravenous adenosine 5’triphosphate (ATP) infusion alone (150 mcg/kg/min) and repeated after further hyperemia induced by adjunctive intracoronary nicorandil injection (2.0 mg). DPa, DPd, and DFFR were defined as the values during ATP and nicorandil minus ATP infusion alone.
iFR was measured (RESOLVE). FFR/iFR discordance was also identified in the IDEAL study in which CFR was determined in addition to FFR and iFR. Median CFR values were compared between the discordant groups to determine if increasing flow during hyperemia explained the FFR+/iFR- discordance. RESULTS From RESOLVE, the prevalence of FFR/iFR discordance was 198/1041 (19.0%), occurring most frequently in the left anterior descending artery (p¼0.047). From IDEAL, the FFR/iFR discordance rate was 54/366 (14.8%). From IDEAL, median CFR was 1.52 (1.16-1.67) in the FFR+ group (n¼129) vs.1.42 (1.15-1.88) in the iFR+ group (n¼142; p¼0.20). In the FFR- (n¼237) and the iFR- (n¼224) groups, the CFR was 2.20 (1.72-2.79) vs. 2.45 (1.90-2.97), respectively (p¼0.07). However, in discordant cases, median CFR was 2.47 (1.98-2.94) with FFR+ and iFR- (n¼19) and 1.44 (1.27-1.86) with FFR- and iFR+ (n¼32; p<0.0001), indicating a closer correlation between CFR and iFR than with CFR and FFR. There were no significant differences in patient or stenosis characteristics between the discordant groups (p>0.05 for all).
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compared fractional myocardial mass (FMM) with multiple angiographic scores. METHODS In this multicenter prospective registry, a total of 453 patients who underwent CCTA followed by invasive coronary angiography were enrolled. Syntax, Gensini, BARI jeopardy, Duke Jeopardy, and APPROACH scores were compared with FMM subtended by vessels with diameter stenosis (DS) 70% (FMM%-70) or 50% (FMM%-50). RESULTS All angiographic scores showed significant correlation each other and also with FMM. Angiographic scores reflecting the amount of jeopardized myocardium (APPROACH and Duke Jeopardy) showed higher correlation (r >0.9) compared with anatomy-based scores (Syntax, Gensini, BARI jeopardy) (r y 0.7).
CONCLUSION Discordance between FFR and iFR occurs in a substantial proportion of cases, nearly one in five. Median CFR is normal (>2.0) in FFR+/iFR- cases and is abnormal (<2.0) in FFR-/iFR+ cases. The inverse relationship between FFR and CFR suggests that hyperemia may confound the identification of flow limiting stenoses with pressure-only indices.
CONCLUSION FMM showed good correlation with angiographic scores which reflects the extent of jeopardized myocardium and prognosis.
CATEGORIES IMAGING: FFR and Physiologic Lesion Assessment
TCT-515 Prognostic implications of instantaneous wave-free ratio (iFR) and resting distal-to-aortic pressure ratio (Pd/Pa) compared with fractional flow reserve (FFR). A 10-year follow-up study after deferral of revascularization
TCT-514 Comparison of angiographic scores and fractional myocardial mass: Use of fractional myocardial mass for comprehensive evaluation of coronary artery disease Hyung Yoon Kim,1 Joon-Hyung Doh,2 Hong-Seok Lim,3 Myeong-Ho Yoon,4 Doo Kyoung Kang,5 Chang-Wook Nam,6 Bon-Kwon Koo,7 Eun Kyoung Kim,8 Seung-Jea Tahk,9 Eun-Seok Shin,10 Sung Mok Kim,11 Yeonhyeon Choe,12 Jin-Ho Choi13 1 Samsung Medical Center, Seoul, Korea, Republic of; 2Inje University Ilsan Paik Hospital; 3Ajou University Medical Center, Suwon, Korea, Republic of; 4Unknown; 5Department of Radiology, Ajou University School of Medicine, Suwon, Korea; 6Keimyung University Dongsan Medical Center, Daegu, Korea, Republic of; 7Seoul National University Hospital, Seoul, Korea, Republic of; 8Turgut Ozal University, Department of Biochemistry; 9Ajou University Medical Center, Suwon, Korea, Republic of; 10Ulsan University Hospital, Ulsan, Korea, Republic of; 11DDepart of Radiology, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; 12Depart of Radiology, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; 13Samsung Medical Center, Seoul, Korea, Republic of BACKGROUND FMM is a vessel-specific myocardial mass derived from coronary computed tomography angiography (CCTA) and enables quantitative assessment of potentially ischemic myocardial mass. We compared FMM with semi-quantitative angiographic scores which have been developed to evaluate the risk and burden of myocardial ischemia but have heterogeneous background. We
CATEGORIES IMAGING: FFR and Physiologic Lesion Assessment
Tim van de Hoef,1 Gilbert Wijntjens,2 Martijn Meuwissen,3 Mauro Echavarria Pinto,4 Martijn van Lavieren,5 Karel Koch,6 Steven Chamuleau,7 Michiel Voskuil,8 Robert de Winter,9 Jan Tijssen,10 Jan Piek11 1 Academic Medical Center - University of Amsterdam, Amsterdam, Netherlands; 2Academisch Medisch Centrum, Amsterdam, Netherlands; 3Breda Amphia Ziekenhuis, Breda, Netherlands; 4Hospital General ISSSTE, Queretaro, Querétaro, Mexico; 5Academic Medical Center- University of Amster, Amsterdam, Netherlands; 6Academic Medical Center - University of Amsterdam, Amsterdam, Netherlands; 7 UMCU, Utrecht, Netherlands; 8UMC Utrecht; 9Academisch Medisch Centrum, Amsterdam, Netherlands; 10AMC-UVA, Naarden, Netherlands; 11University of Amsterdam, Amsterdam, Netherlands BACKGROUND iFR and Pd/Pa are novel indices introduced to enhance adoption of physiology-guided revascularization. Their absolute agreement with FFR is 80%, but both indices agree better with coronary flow reserve (CFR) than FFR. Since CFR is a critical determinant of myocardial ischemia and clinical outcome, we hypothesized that this agreement with CFR results in dominant prognostic value of iFR and Pd/Pa over FFR. METHODS Between 4-1997 and 9-2006, we studied 154 stenoses (154 patients), in which revascularization was deferred, with intracoronary pressure and flow measurements. Follow-up (median 11.8 years) was performed to study the occurrence of adverse events: a composite of
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cardiac death, myocardial infarction and target vessel revascularization (MACE). RESULTS CFR had dominant prognostic value (standardized HR:0.59 (95%CI: 0.43–0.80)), but the association of Pd/Pa with long-term MACE was similar to that of FFR (FFR sHR:0.77 (95%CI: 0.61–0.98); Pd/Pa sHR:0.80 (95%CI: 0.67–0.96)). iFR was available in 44 stenoses, and was also significantly associated with long-term MACE (iFR sHR:0.66 (95%CI: 0.46–0.95)). When Pd/Pa or iFR disagreed with FFR, normal Pd/Pa or iFR was generally associated with normal CFR values and had favorable clinical outcome, whereas abnormal Pd/Pa or iFR was generally associated with CFR values around the ischemic cut-off value and had impaired clinical outcome.
TCT-517 Fractional flow reserve assessment of coronary artery disease in patients Undergoing TAVI. Gabriele Pesarini,1 Roberto Scarsini,2 Carlo Zivelonghi,3 Anna Piccoli,4 Alessia Gambaro,5 Valeria Ferrero,6 Corrado Vassanelli,7 Flavio Ribichini8 1 Ospedale Civile Maggiore Borgo Trento, Verona, Italy; 2University of Verona; 3Azienda ospedaliera universitaria di Verona, Verona, Venice, Italy; 4Athens Medical School, Hippokration Hospital; 5Azienda ospedaliera Verona, Verona, Venice, Italy; 6Unknown, Cuneo, Italy; 7 University of Verona, Verona, Venice, Italy; 8Università di Verona, Verona, Italy BACKGROUND Aortic valve stenosis (AVS) may influence fractional flow reserve (FFR) of concomitant coronary artery disease (CAD) by causing hypertrophy and reducing the vasodilatory reserve of the coronary circulation. The hypothesis was made that TAVI, changing ventricular function by eliminating valvular obstruction, can improve coronary blood flow and then influence the functional assessment of coronary lesions. We sought to investigate if FFR values might change after valve replacement.
CONCLUSION The prognostic value of Pd/Pa and iFR is at least equivalent to FFR. When Pd/Pa or iFR disagrees with FFR, the resting index dominantly determines long-term MACE, likely through better agreement with CFR. CATEGORIES IMAGING: FFR and Physiologic Lesion Assessment TCT-516 Instantaneous-wave Free Ratio and Fractional Flow Reserve Comparison in Patients with and Without Severe Aortic Valve Stenosis. Roberto Scarsini,1 Gabriele Pesarini,2 Carlo Zivelonghi,3 Anna Piccoli,4 Alessia Gambaro,5 Corrado Vassanelli,6 Flavio Ribichini7 1 University of Verona; 2Ospedale Civile Maggiore Borgo Trento, Verona, Italy; 3Azienda ospedaliera universitaria di Verona, Verona, Venice, Italy; 4Athens Medical School, Hippokration Hospital; 5Azienda ospedaliera Verona, Verona, Venice, Italy; 6University of Verona, Verona, Venice, Italy; 7Università di Verona, Verona, Italy BACKGROUND Fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) have not been extensively investigated in patients with severe aortic valve stenosis(AVS) and concomitant coronary artery disease(CAD). The aim of this study was to compare FFR and iFR measurements in patients with severe symptomatic AVS and in patients without AVS, and to correlate these findings with angiographic quantitative coronary analysis (QCA). METHODS FFR and iFR were prospectively measured in the major coronary artery branches of patients undergoing diagnostic coronary angiography as part of the workout for TAVI. Quantitative Coronary Angiography(QCA) was blinded of the FFR-iFR results. These were compared with a matched control group of CAD patients without any valve disease. An FFR value 0.80 was considered pathologic while an FFR value >0.80 was considered ‘negative’. ROC curve analysis was performed in order to find the diagnostic accuracy and the optimal diagnostic cut-off value of iFR in predicting postive FFR (0.80) in the AVS and in the CAD population. RESULTS One-hundred-sixty-six patients (54 AVS and 112 CAD) with 393 lesions (131 AVS and 262 CAD) were enrolled. Correlation between FFR-iFR and QCA parameters was modest but remained constant in patients with AVS. FFR-iFR correlation was maintained in AVS compared with CAD patients, and the iFR accuracy for predicting FFR0.8 was similar between the two groups (AUC:0.94 vs 0.96, p¼0.45). Using the current cutoff point of iFR0.9 for predicting a positive FFR, the false positive rate was 22.6% in the AVS group compared to 16.5% in the CAD group (p¼0.27), with a positive predictive value of 41% and 71.7% for AVS and CAD patients respectively. At ROC curve analysis the best cut-off of iFR predicting FFR0.8 was lower in patients with AVS compared with CAD patients: 0.84 (J¼0.82) vs 0.88 (J¼0.81). CONCLUSION AVS may influence functional assessment of concomitant CAD. FFR-iFR correlation in AVS resulted poorer compared with CAD patients. The 0.90 iFR cut-off value to match 0.80 FFR cut-off may defer in AVS patients and deserves further comparative studies. CATEGORIES IMAGING: FFR and Physiologic Lesion Assessment
METHODS In this prospective, observational study, FFR measurements were attempted in the three major epicardial arteries before TAVI and immediately after the trans-catheter valve implantation maintaining similar hemodynamic conditions. The functional relevance of 120 coronary lesions was assessed by FFR in 47 patients with severe AVS. Comparison of variables before and after TAVI was performed using a paired Student’s t-test. RESULTS No significant overall change in FFR values was found before and after TAVI (0.880.10 vs (0.890.12, p¼0.65). Positive FFR values at baseline (0.8), worsened after TAVI: 0.710.11 vs 0.650.13, p¼0.001. Conversely, negative FFR values at baseline improved: 0.910.05 vs 0.930.07, p¼0.01. Similarly, FFR values in arteries with mild lesions (%DS<50) improved after TAVI (0.920.06 vs 0.930.07, p¼0.03), while lesions with %DS>50 tended toward worsening (0.820.12 vs 0.800.16, p¼0.17). Functional FFR variations after TAVI changed the indication to treat the coronary stenosis in 7 out of 120 (5.8%) of lesions, (15% of patients). CONCLUSION Coronary hemodynamics are influenced by AVS removal. Nevertheless, FFR variations after TAVI are minor and crossed the diagnostic cut-off of 0.8 in a small number of patients after valve replacement. Borderline coronary lesions might become functionally significant after valve replacement, although FFR-guided interventions were infrequent even in patients with angiographically significant lesions. CATEGORIES IMAGING: FFR and Physiologic Lesion Assessment
TCT-518 The Interaction between Aortic and Coronary Pressures for Fractional Flow Reserve Value in Patients with an Intermediate Coronary Artery Stenosis Hiroyuki Okura,1 Yuhei Kobayashi,2 Yoji Neishi,3 Tomitaka Higa,4 Yukari Kobayashi,5 Shiro Uemura,6 Kiyoshi Yoshida7 1 Nara Medical University, Kashihara, Japan; 2Stanford University, Stanford, California, United States; 3Kawasaki Medical School, Kurashiki, Japan; 4Kawasaki Mecical School; 5Stanford University, Stanford, California, United States; 6Kawasaki Medical School, Kurashiki, Japan; 7The Sakakibara Heart Institute of Okayama BACKGROUND Fractional flow reserve (FFR) has been used as an index unaffectd by hemodynamic alteration. However, there is a theoretical concern that the further decrement of aortic pressure may result in artificially elevated FFR value. The aim of this study was to investigate relationship between alterations in aortic blood pressure and changes in FFR after adjunctive intracoronary nicorandil. METHODS A total of 183 intermediate native coronary artery lesions from 112 patients were prospectively enrolled to this study. The mean aortic pressure (Pa), the mean distal coronary pressure (Pd), and FFR were measured during intravenous adenosine 5’triphosphate (ATP) infusion alone (150 mcg/kg/min) and repeated after further hyperemia induced by adjunctive intracoronary nicorandil injection (2.0 mg). DPa, DPd, and DFFR were defined as the values during ATP and nicorandil minus ATP infusion alone.