Correlation between intracoronary physiology and myocardial perfusion imaging in patients with severe aortic stenosis

Scarsini, Roberto; Cantone, Rosaria; Venturi, Gabriele; Maria, Giovanni Luigi De; Variola, A; Braggio, Paolo; Lunardi, Mattia; Pesarini, Gabriele; Ferdeghini, M; Piccoli, Anna; Feola, Mauro; Kharbanda, Rajesh; Ribichini, Flavio

doi:10.1016/j.ijcard.2019.04.050

Cited by 29 publications

(31 citation statements)

References 12 publications

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“…On the contrary the iFR best cut-off in detecting ischemia was significantly lower in AS (0.82 vs. 0.89). Lowering the iFR cut-off for detecting ischemia was also reported by other groups of investigators and it could be used to reduce unnecessary CAD treatment in TAVI candidates [35][36][37][38] (Table 2). Other novel non-hyperemic pressure-wire indices may have the potential to be used to functionally assess coronary lesions in patients undergoing TAVI.…”

Section: Invasive Physiological Assessmentmentioning

confidence: 60%

Aortic Valve Disease and Associated Complex CAD: The Interventional Approach

Marin

Scarsini

Kotronias

et al. 2021

JCM

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Coronary artery disease (CAD) is highly prevalent in patients with severe aortic stenosis (AS). The management of CAD is a central aspect of the work-up of patients undergoing transcatheter aortic valve implantation (TAVI), but few data are available on this field and the best percutaneous coronary intervention (PCI) practice is yet to be determined. A major challenge is the ability to elucidate the severity of bystander coronary stenosis independently of the severity of aortic valve stenosis and subsequent impact on blood flow. The prognostic role of CAD in patients undergoing TAVI is being still debated and the benefits and the best timing of PCI in this context are currently under evaluation. Additionally, PCI in the setting of advanced AS poses some technical challenges, due to the complex anatomy, risk of hemodynamic instability, and the increased risk of bleeding complications. This review aims to provide a comprehensive synthesis of the available literature on myocardial revascularization in patients with severe AS undergoing TAVI. This work can assist the Heart Team in individualizing decisions about myocardial revascularization, taking into account available diagnostic tools as well as the risks and benefits.

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Section: Invasive Physiological Assessmentmentioning

confidence: 60%

Aortic Valve Disease and Associated Complex CAD: The Interventional Approach

Marin

Scarsini

Kotronias

et al. 2021

JCM

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“…Scarsini et al . revealed substantial agreement between stress MPI and fractional flow reserve (FFR) and high negative predictive value (NPV) in identifying coronary lesions 39 . Our findings agreed that vasodilator stress can be a valuable tool to evaluate dipyridamole-induced ischemia in patients with AS and guide the treatment strategy.…”

Section: Discussionmentioning

confidence: 96%

The clinical value and safety of ECG-gated dipyridamole myocardial perfusion imaging in patients with aortic stenosis

Liu

Wang

Shiau

et al. 2019

Sci Rep

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The role of vasodilator myocardial perfusion imaging (MPI) for aortic stenosis (AS) is controversial due to safety and accuracy concerns. In addition, its utility after aortic valve (AV) interventions remains unclear. Patients with AS who underwent thallium-201-gated dipyridamole MPI using a cadmium-zinc-telluride camera were retrospectively reviewed and divided into three groups: mild AS, moderate-to-severe AS, and prior AV interventions. Patients with coronary artery disease with ≥50% stenosis, severe arrhythmia, left ventricular ejection fraction (LVEF) <40%, left bundle branch block or no follow-up were excluded. Relationships between the severity of AS, clinical characteristics, hemodynamic response, serious adverse events (SAE) and MPI parameters were analyzed. None of the 47 patients had SAE, including significant hypotension or LVEF reduction. The moderate-to-severe AS group had higher summed stress scores (SSSs) and depressed LVEF than the mild AS group, however there were no differences after AV interventions. SSS was positively correlated with AV mean pressure gradient, post-stress lung-heart ratio (LHRs), and post-stress end-diastolic volume (EDVs) ( P < 0.05). In multivariate analysis, LHRs and EDVs were independent contributors to SSS. Dipyridamole-induced ischemia and LV dysfunction is common, and dipyridamole stress could be a safe diagnostic tool in evaluation and follow-up in patients with AS.

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“…ese theoretical findings are consistent with relevant clinical observations reported in the literature. For instance, it was found that in patients with severe AS, the conventional iFR cutoff value had lower diagnostic agreement with FFR in the classification of coronary lesions and that a lower iFR cutoff value (e.g., shifting the cutoff value from 0.89 to 0.83) should be used in order to better predict a positive FFR [12,13,45,46]. In the case of increasing severity of AR (simulated by increasing the value assigned to EOA dia in the model), our study revealed similar patterns of differential changes in iFR and FFR to those found in the case of increasing severity of AS and would cause a similar trend of discordant diagnosis between iFR and FFR, although relevant clinical evidence from studies focused on patients with AR is rare, probably due to the low prevalence of AR in patients with coronary artery disease [47].…”

Section: Discussionmentioning

confidence: 99%

Comparison of Instantaneous Wave-Free Ratio (iFR) and Fractional Flow Reserve (FFR) with respect to Their Sensitivities to Cardiovascular Factors: A Computational Model-Based Study

Liu

Yin

et al. 2020

Journal of Interventional Cardiology

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While coronary revascularization strategies guided by instantaneous wave-free ratio (iFR) are, in general, noninferior to those guided by fractional flow reserve (FFR) with respect to the rate of major adverse cardiac events at one-year follow-up in patients with stable angina or an acute coronary syndrome, the overall accuracy of diagnosis with iFR in large patient cohorts is about 80% compared with the diagnosis with FFR. So far, it remains incompletely understood what factors contribute to the discordant diagnosis between iFR and FFR. In this study, a computational method was used to systemically investigate the respective effects of various cardiovascular factors on FFR and iFR. The results showed that deterioration in aortic valve disease (e.g., regurgitation or stenosis) led to a marked decrease in iFR and a mild increase in FFR given fixed severity of coronary artery stenosis and that increasing coronary microvascular resistance caused a considerable increase in both iFR and FFR, but the degree of increase in iFR was lower than that in FFR. These findings suggest that there is a high probability of discordant diagnosis between iFR and FFR in patients with severe aortic valve disease or coronary microcirculation dysfunction.

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Correlation between intracoronary physiology and myocardial perfusion imaging in patients with severe aortic stenosis

Cited by 29 publications

References 12 publications

Aortic Valve Disease and Associated Complex CAD: The Interventional Approach

Aortic Valve Disease and Associated Complex CAD: The Interventional Approach

The clinical value and safety of ECG-gated dipyridamole myocardial perfusion imaging in patients with aortic stenosis

Comparison of Instantaneous Wave-Free Ratio (iFR) and Fractional Flow Reserve (FFR) with respect to Their Sensitivities to Cardiovascular Factors: A Computational Model-Based Study

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