Determining the Predominant Lesion in Patients With Severe Aortic Stenosis and Coronary Stenoses: A Multicenter Study Using Intracoronary Pressure and Flow

Yousif Ahmad, Jeroen Vendrik, Ashkan Eftekhari, James P. Howard, Christopher Cook, Christopher Rajkumar, Iqbal Malik, Ghada Mikhail, Neil Ruparelia, Nearchos Hadjiloizou, Sukhjinder Nijjer, Rasha Al-Lamee, Ricardo Petraco, Takayuki Warisawa, Gilbert W. M. Wijntjens, Karel T. Koch, Tim van de Hoef, Guus de Waard, Mauro Echavarria-Pinto, Angela Frame & 20 others Nilesh Sutaria, Gajen Kanaganayagam, Ben Ariff, Jon Anderson, Andrew Chukwuemeka, Michael Fertleman, Sasha Koul, Juan F. Iglesias, Darrel Francis, Jamil Mayet, Patrick Serruys, Justin Davies, Javier Escaned, Niels van Royen, Matthias Götberg, Christian Juhl Terkelsen, Evald Høj Christiansen, Jan J. Piek, Jan Baan, Sayan Sen

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

BACKGROUND: Patients with severe aortic stenosis (AS) often have coronary artery disease. Both the aortic valve and the coronary disease influence the blood flow to the myocardium and its ability to respond to stress; leading to exertional symptoms. In this study, we aim to quantify the effect of severe AS on the coronary microcirculation and determine if this is influenced by any concomitant coronary disease. We then compare this to the effect of coronary stenoses on the coronary microcirculation. METHODS: Group 1: 55 patients with severe AS and intermediate coronary stenoses treated with transcatheter aortic valve implantation (TAVI) were included. Group 2: 85 patients with intermediate coronary stenoses and no AS treated with percutaneous coronary intervention were included. Coronary pressure and flow were measured at rest and during hyperemia in both groups, before and after TAVI (group 1) and before and after percutaneous coronary intervention (group 2). RESULTS: Microvascular resistance over the wave-free period of diastole increased significantly post-TAVI (pre-TAVI, 2.71±1.4 mm Hg·cm·s-1 versus post-TAVI 3.04±1.6 mm Hg·cm·s-1 [P=0.03]). Microvascular reserve over the wave-free period of diastole significantly improved post-TAVI (pre-TAVI 1.88±1.0 versus post-TAVI 2.09±0.8 [P=0.003]); this was independent of the severity of the underlying coronary stenosis. The change in microvascular resistance post-TAVI was equivalent to that produced by stenting a coronary lesion with an instantaneous wave-free ratio of ≤0.74. CONCLUSIONS: TAVI improves microcirculatory function regardless of the severity of underlying coronary disease. TAVI for severe AS produces a coronary hemodynamic improvement equivalent to the hemodynamic benefit of stenting coronary stenoses with instantaneous wave-free ratio values <0.74. Future trials of physiology-guided revascularization in severe AS may consider using this value to guide treatment of concomitant coronary artery disease.
Original languageEnglish
Pages (from-to)e008263
JournalCirculation-cardiovascular interventions
Volume12
Issue number12
DOIs
Publication statusPublished - 2019

Cite this

Ahmad, Yousif ; Vendrik, Jeroen ; Eftekhari, Ashkan ; Howard, James P. ; Cook, Christopher ; Rajkumar, Christopher ; Malik, Iqbal ; Mikhail, Ghada ; Ruparelia, Neil ; Hadjiloizou, Nearchos ; Nijjer, Sukhjinder ; Al-Lamee, Rasha ; Petraco, Ricardo ; Warisawa, Takayuki ; Wijntjens, Gilbert W. M. ; Koch, Karel T. ; van de Hoef, Tim ; de Waard, Guus ; Echavarria-Pinto, Mauro ; Frame, Angela ; Sutaria, Nilesh ; Kanaganayagam, Gajen ; Ariff, Ben ; Anderson, Jon ; Chukwuemeka, Andrew ; Fertleman, Michael ; Koul, Sasha ; Iglesias, Juan F. ; Francis, Darrel ; Mayet, Jamil ; Serruys, Patrick ; Davies, Justin ; Escaned, Javier ; van Royen, Niels ; Götberg, Matthias ; Juhl Terkelsen, Christian ; Høj Christiansen, Evald ; Piek, Jan J. ; Baan, Jan ; Sen, Sayan. / Determining the Predominant Lesion in Patients With Severe Aortic Stenosis and Coronary Stenoses: A Multicenter Study Using Intracoronary Pressure and Flow. In: Circulation-cardiovascular interventions. 2019 ; Vol. 12, No. 12. pp. e008263.
@article{e3a6acab62b544aba028660ec75ae263,
title = "Determining the Predominant Lesion in Patients With Severe Aortic Stenosis and Coronary Stenoses: A Multicenter Study Using Intracoronary Pressure and Flow",
abstract = "BACKGROUND: Patients with severe aortic stenosis (AS) often have coronary artery disease. Both the aortic valve and the coronary disease influence the blood flow to the myocardium and its ability to respond to stress; leading to exertional symptoms. In this study, we aim to quantify the effect of severe AS on the coronary microcirculation and determine if this is influenced by any concomitant coronary disease. We then compare this to the effect of coronary stenoses on the coronary microcirculation. METHODS: Group 1: 55 patients with severe AS and intermediate coronary stenoses treated with transcatheter aortic valve implantation (TAVI) were included. Group 2: 85 patients with intermediate coronary stenoses and no AS treated with percutaneous coronary intervention were included. Coronary pressure and flow were measured at rest and during hyperemia in both groups, before and after TAVI (group 1) and before and after percutaneous coronary intervention (group 2). RESULTS: Microvascular resistance over the wave-free period of diastole increased significantly post-TAVI (pre-TAVI, 2.71±1.4 mm Hg·cm·s-1 versus post-TAVI 3.04±1.6 mm Hg·cm·s-1 [P=0.03]). Microvascular reserve over the wave-free period of diastole significantly improved post-TAVI (pre-TAVI 1.88±1.0 versus post-TAVI 2.09±0.8 [P=0.003]); this was independent of the severity of the underlying coronary stenosis. The change in microvascular resistance post-TAVI was equivalent to that produced by stenting a coronary lesion with an instantaneous wave-free ratio of ≤0.74. CONCLUSIONS: TAVI improves microcirculatory function regardless of the severity of underlying coronary disease. TAVI for severe AS produces a coronary hemodynamic improvement equivalent to the hemodynamic benefit of stenting coronary stenoses with instantaneous wave-free ratio values <0.74. Future trials of physiology-guided revascularization in severe AS may consider using this value to guide treatment of concomitant coronary artery disease.",
author = "Yousif Ahmad and Jeroen Vendrik and Ashkan Eftekhari and Howard, {James P.} and Christopher Cook and Christopher Rajkumar and Iqbal Malik and Ghada Mikhail and Neil Ruparelia and Nearchos Hadjiloizou and Sukhjinder Nijjer and Rasha Al-Lamee and Ricardo Petraco and Takayuki Warisawa and Wijntjens, {Gilbert W. M.} and Koch, {Karel T.} and {van de Hoef}, Tim and {de Waard}, Guus and Mauro Echavarria-Pinto and Angela Frame and Nilesh Sutaria and Gajen Kanaganayagam and Ben Ariff and Jon Anderson and Andrew Chukwuemeka and Michael Fertleman and Sasha Koul and Iglesias, {Juan F.} and Darrel Francis and Jamil Mayet and Patrick Serruys and Justin Davies and Javier Escaned and {van Royen}, Niels and Matthias G{\"o}tberg and {Juhl Terkelsen}, Christian and {H{\o}j Christiansen}, Evald and Piek, {Jan J.} and Jan Baan and Sayan Sen",
year = "2019",
doi = "10.1161/CIRCINTERVENTIONS.119.008263",
language = "English",
volume = "12",
pages = "e008263",
journal = "Circulation-cardiovascular interventions",
issn = "1941-7640",
publisher = "Lippincott Williams and Wilkins",
number = "12",

}

Ahmad, Y, Vendrik, J, Eftekhari, A, Howard, JP, Cook, C, Rajkumar, C, Malik, I, Mikhail, G, Ruparelia, N, Hadjiloizou, N, Nijjer, S, Al-Lamee, R, Petraco, R, Warisawa, T, Wijntjens, GWM, Koch, KT, van de Hoef, T, de Waard, G, Echavarria-Pinto, M, Frame, A, Sutaria, N, Kanaganayagam, G, Ariff, B, Anderson, J, Chukwuemeka, A, Fertleman, M, Koul, S, Iglesias, JF, Francis, D, Mayet, J, Serruys, P, Davies, J, Escaned, J, van Royen, N, Götberg, M, Juhl Terkelsen, C, Høj Christiansen, E, Piek, JJ, Baan, J & Sen, S 2019, 'Determining the Predominant Lesion in Patients With Severe Aortic Stenosis and Coronary Stenoses: A Multicenter Study Using Intracoronary Pressure and Flow' Circulation-cardiovascular interventions, vol. 12, no. 12, pp. e008263. https://doi.org/10.1161/CIRCINTERVENTIONS.119.008263

Determining the Predominant Lesion in Patients With Severe Aortic Stenosis and Coronary Stenoses: A Multicenter Study Using Intracoronary Pressure and Flow. / Ahmad, Yousif; Vendrik, Jeroen; Eftekhari, Ashkan; Howard, James P.; Cook, Christopher; Rajkumar, Christopher; Malik, Iqbal; Mikhail, Ghada; Ruparelia, Neil; Hadjiloizou, Nearchos; Nijjer, Sukhjinder; Al-Lamee, Rasha; Petraco, Ricardo; Warisawa, Takayuki; Wijntjens, Gilbert W. M.; Koch, Karel T.; van de Hoef, Tim; de Waard, Guus; Echavarria-Pinto, Mauro; Frame, Angela; Sutaria, Nilesh; Kanaganayagam, Gajen; Ariff, Ben; Anderson, Jon; Chukwuemeka, Andrew; Fertleman, Michael; Koul, Sasha; Iglesias, Juan F.; Francis, Darrel; Mayet, Jamil; Serruys, Patrick; Davies, Justin; Escaned, Javier; van Royen, Niels; Götberg, Matthias; Juhl Terkelsen, Christian; Høj Christiansen, Evald; Piek, Jan J.; Baan, Jan; Sen, Sayan.

In: Circulation-cardiovascular interventions, Vol. 12, No. 12, 2019, p. e008263.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Determining the Predominant Lesion in Patients With Severe Aortic Stenosis and Coronary Stenoses: A Multicenter Study Using Intracoronary Pressure and Flow

AU - Ahmad, Yousif

AU - Vendrik, Jeroen

AU - Eftekhari, Ashkan

AU - Howard, James P.

AU - Cook, Christopher

AU - Rajkumar, Christopher

AU - Malik, Iqbal

AU - Mikhail, Ghada

AU - Ruparelia, Neil

AU - Hadjiloizou, Nearchos

AU - Nijjer, Sukhjinder

AU - Al-Lamee, Rasha

AU - Petraco, Ricardo

AU - Warisawa, Takayuki

AU - Wijntjens, Gilbert W. M.

AU - Koch, Karel T.

AU - van de Hoef, Tim

AU - de Waard, Guus

AU - Echavarria-Pinto, Mauro

AU - Frame, Angela

AU - Sutaria, Nilesh

AU - Kanaganayagam, Gajen

AU - Ariff, Ben

AU - Anderson, Jon

AU - Chukwuemeka, Andrew

AU - Fertleman, Michael

AU - Koul, Sasha

AU - Iglesias, Juan F.

AU - Francis, Darrel

AU - Mayet, Jamil

AU - Serruys, Patrick

AU - Davies, Justin

AU - Escaned, Javier

AU - van Royen, Niels

AU - Götberg, Matthias

AU - Juhl Terkelsen, Christian

AU - Høj Christiansen, Evald

AU - Piek, Jan J.

AU - Baan, Jan

AU - Sen, Sayan

PY - 2019

Y1 - 2019

N2 - BACKGROUND: Patients with severe aortic stenosis (AS) often have coronary artery disease. Both the aortic valve and the coronary disease influence the blood flow to the myocardium and its ability to respond to stress; leading to exertional symptoms. In this study, we aim to quantify the effect of severe AS on the coronary microcirculation and determine if this is influenced by any concomitant coronary disease. We then compare this to the effect of coronary stenoses on the coronary microcirculation. METHODS: Group 1: 55 patients with severe AS and intermediate coronary stenoses treated with transcatheter aortic valve implantation (TAVI) were included. Group 2: 85 patients with intermediate coronary stenoses and no AS treated with percutaneous coronary intervention were included. Coronary pressure and flow were measured at rest and during hyperemia in both groups, before and after TAVI (group 1) and before and after percutaneous coronary intervention (group 2). RESULTS: Microvascular resistance over the wave-free period of diastole increased significantly post-TAVI (pre-TAVI, 2.71±1.4 mm Hg·cm·s-1 versus post-TAVI 3.04±1.6 mm Hg·cm·s-1 [P=0.03]). Microvascular reserve over the wave-free period of diastole significantly improved post-TAVI (pre-TAVI 1.88±1.0 versus post-TAVI 2.09±0.8 [P=0.003]); this was independent of the severity of the underlying coronary stenosis. The change in microvascular resistance post-TAVI was equivalent to that produced by stenting a coronary lesion with an instantaneous wave-free ratio of ≤0.74. CONCLUSIONS: TAVI improves microcirculatory function regardless of the severity of underlying coronary disease. TAVI for severe AS produces a coronary hemodynamic improvement equivalent to the hemodynamic benefit of stenting coronary stenoses with instantaneous wave-free ratio values <0.74. Future trials of physiology-guided revascularization in severe AS may consider using this value to guide treatment of concomitant coronary artery disease.

AB - BACKGROUND: Patients with severe aortic stenosis (AS) often have coronary artery disease. Both the aortic valve and the coronary disease influence the blood flow to the myocardium and its ability to respond to stress; leading to exertional symptoms. In this study, we aim to quantify the effect of severe AS on the coronary microcirculation and determine if this is influenced by any concomitant coronary disease. We then compare this to the effect of coronary stenoses on the coronary microcirculation. METHODS: Group 1: 55 patients with severe AS and intermediate coronary stenoses treated with transcatheter aortic valve implantation (TAVI) were included. Group 2: 85 patients with intermediate coronary stenoses and no AS treated with percutaneous coronary intervention were included. Coronary pressure and flow were measured at rest and during hyperemia in both groups, before and after TAVI (group 1) and before and after percutaneous coronary intervention (group 2). RESULTS: Microvascular resistance over the wave-free period of diastole increased significantly post-TAVI (pre-TAVI, 2.71±1.4 mm Hg·cm·s-1 versus post-TAVI 3.04±1.6 mm Hg·cm·s-1 [P=0.03]). Microvascular reserve over the wave-free period of diastole significantly improved post-TAVI (pre-TAVI 1.88±1.0 versus post-TAVI 2.09±0.8 [P=0.003]); this was independent of the severity of the underlying coronary stenosis. The change in microvascular resistance post-TAVI was equivalent to that produced by stenting a coronary lesion with an instantaneous wave-free ratio of ≤0.74. CONCLUSIONS: TAVI improves microcirculatory function regardless of the severity of underlying coronary disease. TAVI for severe AS produces a coronary hemodynamic improvement equivalent to the hemodynamic benefit of stenting coronary stenoses with instantaneous wave-free ratio values <0.74. Future trials of physiology-guided revascularization in severe AS may consider using this value to guide treatment of concomitant coronary artery disease.

UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85075494229&origin=inward

UR - https://www.ncbi.nlm.nih.gov/pubmed/31752515

U2 - 10.1161/CIRCINTERVENTIONS.119.008263

DO - 10.1161/CIRCINTERVENTIONS.119.008263

M3 - Article

VL - 12

SP - e008263

JO - Circulation-cardiovascular interventions

JF - Circulation-cardiovascular interventions

SN - 1941-7640

IS - 12

ER -