Fractional Flow Reserve Assessment of Epicardial Coronary Artery Stenosis in the Setting of Severe Degenerative Valvular Aortic Stenosis

Abstract

Introduction: Fractional flow reserve (FFR) has an established role in the assessment of coronary artery disease (CAD) where angiographic information alone is insufficient to guide revascularisation decisions. More than 50% of degenerative valvular aortic stenosis (AS) have significant CAD. Little data pertains to lesion assessment with FFR in patients with severe AS, particularly the safety, feasibility and accuracy given the altered coronary physiology in aortic stenosis. Methods: The Prince Charles Hospital Catheterisation Laboratory Database was analysed. Patients were identified with severe AS on echocardiographic criteria (American Heart Association/American College of Cardiology Guidelines) who underwent of FFR assessment of at least one epicardial stenosis. Patient characteristics, procedural data and safety were analysed. Results: Eight patients (4 male, 4 female) were identified in the period from January 2010 to March 2012. Median age 84 years (62–92). Median baseline and post adenosine FFR were 0.91 and 0.86 respectively. Echocardiographic parameters: median LVEF 66% (52–79%), median AV area 0.8 cm2, median mean AV pressure gradient 51.5 mmHg, median peak AV velocity 4.5 m/s, median dimensionless performance index 0.2. Procedural success was 100%. There were no periprocedural complications related to FFR evaluation in this group. No patient developed acute deterioration necessitating haemodynamic support. Conclusions: This cohort demonstrates that FFR assessment can be performed safely in the setting of severe AS. However, the validity of FFR measurement in this population requires further investigation.