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@article{Ahmad:2018:10.1016/j.jcin.2018.07.019,
author = {Ahmad, Y and Götberg, M and Cook, C and Howard, J and Malik, I and Mikhail, G and Frame, A and Petraco, R and Rajkumar, C and Demir, O and Iglesias, JF and Bhindi, R and Koul, S and Hadjiloizou, N and Gerber, R and Ramrakha, P and Ruparelia, N and Sutaria, N and Kanaganayagam, G and Ariff, B and Fertleman, M and Anderson, J and Chukwuemeka, A and Francis, D and Mayet, J and Serruys, P and Davies, J and Sen, S},
doi = {10.1016/j.jcin.2018.07.019},
journal = {JACC: Cardiovascular Interventions},
pages = {2019--2031},
title = {Coronary hemodynamics in patients with severe aortic stenosis and coronary Artery disease undergoing transcatheter aortic valve replacement: implications for clinical indices of coronary stenosis severity},
url = {http://dx.doi.org/10.1016/j.jcin.2018.07.019},
volume = {11},
year = {2018}
}

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TY  - JOUR
AB  - OBJECTIVES: In this study, a systematic analysis was conducted of phasic intracoronary pressure and flow velocity in patients with severe aortic stenosis (AS) and coronary artery disease, undergoing transcatheter aortic valve replacement (TAVR), to determine how AS affects 1) phasic coronary flow; 2) hyperemic coronary flow; and 3) the most common clinically used indices of coronary stenosis severity, instantaneous wave-free ratio and fractional flow reserve. BACKGROUND: A significant proportion of patients with severe aortic stenosis (AS) have concomitant coronary artery disease. The effect of the valve on coronary pressure, flow, and the established invasive clinical indices of stenosis severity have not been studied. METHODS: Twenty-eight patients (30 lesions, 50.0% men, mean age 82.1 ± 6.5 years) with severe AS and coronary artery disease were included. Intracoronary pressure and flow assessments were performed at rest and during hyperemia immediately before and after TAVR. RESULTS: Flow during the wave-free period of diastole did not change post-TAVR (29.78 ± 14.9 cm/s vs. 30.81 ± 19.6 cm/s, p = 0.64). Whole-cycle hyperemic flow increased significantly post-TAVR (33.44 ± 13.4 cm/s pre-TAVR vs. 40.33 ± 17.4 cm/s post-TAVR, p = 0.006); this was secondary to significant increases in systolic hyperemic flow post-TAVR (27.67 ± 12.1 cm/s pre-TAVR vs. 34.15 ± 17.5 cm/s post-TAVR, p = 0.02). Instantaneous wave-free ratio values did not change post-TAVR (0.88 ± 0.09 pre-TAVR vs. 0.88 ± 0.09 post-TAVR, p = 0.73), whereas fractional flow reserve decreased significantly post-TAVR (0.87 ± 0.08 pre-TAVR vs. 0.85 ± 0.09 post-TAVR, p = 0.001). CONCLUSIONS: Systolic and hyperemic coronary flow increased significantly post-TAVR; consequently, hyperemic indices that include systole underestimated coronary stenosis severity in patients with severe AS. Flow during the wave-free per
AU  - Ahmad,Y
AU  - Götberg,M
AU  - Cook,C
AU  - Howard,J
AU  - Malik,I
AU  - Mikhail,G
AU  - Frame,A
AU  - Petraco,R
AU  - Rajkumar,C
AU  - Demir,O
AU  - Iglesias,JF
AU  - Bhindi,R
AU  - Koul,S
AU  - Hadjiloizou,N
AU  - Gerber,R
AU  - Ramrakha,P
AU  - Ruparelia,N
AU  - Sutaria,N
AU  - Kanaganayagam,G
AU  - Ariff,B
AU  - Fertleman,M
AU  - Anderson,J
AU  - Chukwuemeka,A
AU  - Francis,D
AU  - Mayet,J
AU  - Serruys,P
AU  - Davies,J
AU  - Sen,S
DO  - 10.1016/j.jcin.2018.07.019
EP  - 2031
PY  - 2018///
SN  - 1936-8798
SP  - 2019
TI  - Coronary hemodynamics in patients with severe aortic stenosis and coronary Artery disease undergoing transcatheter aortic valve replacement: implications for clinical indices of coronary stenosis severity
T2  - JACC: Cardiovascular Interventions
UR  - http://dx.doi.org/10.1016/j.jcin.2018.07.019
UR  - https://www.ncbi.nlm.nih.gov/pubmed/30154062
UR  - http://hdl.handle.net/10044/1/63201
VL  - 11
ER  -

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