Natural History of Coronary Atherosclerosis in Patients With Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement: The Role of Quantitative Flow Ratio.

IF 6.1 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS
Iginio Colaiori, Luca Paolucci, Fabio Mangiacapra, Emanuele Barbato, Gian Paolo Ussia, Francesco Grigioni, Pierluigi Demola, Marco Vitolo, Giorgio Benatti, Luigi Vignali, Davide Gabbieri, Paolo Magnavacchi, Fabio Alfredo Sgura, Giuseppe Boriani, Vincenzo Guiducci
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引用次数: 0

Abstract

Background: The prognostic impact of functionally significant coronary artery disease, as assessed with quantitative flow ratio (QFR), in patients with severe aortic stenosis treated with transcatheter aortic valve replacement is unknown.

Methods: This is a retrospective study with blind analysis of angiographic data, enrolling consecutive patients with severe aortic stenosis treated with transcatheter aortic valve replacement at 4 Italian centers. None of the patients enrolled received pre-transcatheter aortic valve replacement or concomitant coronary revascularization, either for the absence of significant coronary stenoses or by clinical decision. Visual estimation of diameter stenosis and QFR analysis were performed in all coronary arteries. The end point was all-cause mortality at a 3-year follow-up.

Results: A total of 318 patients were enrolled. At visual estimation, 140 patients (44%) presented a diameter stenosis ≥50% in at least 1 coronary artery, whereas 78 patients (24.5%) had at least 1 vessel with QFR <0.80 and, therefore, included in the positive QFR group. Overall, 69 (21.7%) patients died during the follow-up. In the Kaplan-Meier analysis, patients with positive QFR experienced significantly higher rates of death during follow-up compared with those without (51.1% versus 12.1%; P<0.001), whereas no significant difference was evident in terms of death between patients with or without significant coronary artery disease according to angiographic evaluation (24.3% versus 19.7%; P=0.244). In a multivariate regression model, positive QFR was an independent predictor of all-cause death during follow-up (hazard ratio, 5.31 [95% CI, 3.21-8.76]).

Conclusions: Coronary QFR can predict mortality in patients with severe aortic stenosis treated with transcatheter aortic valve replacement without revascularization.

接受经导管主动脉瓣置换术的主动脉瓣狭窄患者冠状动脉粥样硬化的自然病史:定量血流比率的作用。
背景:在接受经导管主动脉瓣置换术治疗的重度主动脉瓣狭窄患者中,用定量血流比(QFR)评估功能显著的冠状动脉疾病对预后的影响尚不清楚:这是一项对血管造影数据进行盲法分析的回顾性研究,研究对象是在意大利 4 个中心接受经导管主动脉瓣置换术治疗的连续重度主动脉瓣狭窄患者。所有入选患者在接受经导管主动脉瓣置换术前均未接受冠状动脉血运重建,原因是没有明显的冠状动脉狭窄或由临床决定。对所有冠状动脉进行了直径狭窄目测和QFR分析。终点是随访 3 年的全因死亡率:结果:共有 318 名患者入选。目测结果显示,140 名患者(44%)至少有一根冠状动脉的直径狭窄≥50%,而 78 名患者(24.5%)至少有一根血管的 QFR PP=0.244)。在多变量回归模型中,QFR阳性是随访期间全因死亡的独立预测因素(危险比为5.31 [95% CI, 3.21-8.76]):结论:冠状动脉QFR可预测接受经导管主动脉瓣置换术治疗的重度主动脉瓣狭窄患者的死亡率。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Circulation: Cardiovascular Interventions
Circulation: Cardiovascular Interventions CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
10.30
自引率
1.80%
发文量
221
审稿时长
6-12 weeks
期刊介绍: Circulation: Cardiovascular Interventions, an American Heart Association journal, focuses on interventional techniques pertaining to coronary artery disease, structural heart disease, and vascular disease, with priority placed on original research and on randomized trials and large registry studies. In addition, pharmacological, diagnostic, and pathophysiological aspects of interventional cardiology are given special attention in this online-only journal.
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