E-Abstract

JACC

Lots of interesting abstracts and cases were submitted for TCTAP 2023. Below are the accepted ones after a thorough review by our official reviewers. Don’t miss the opportunity to expand your knowledge and interact with authors as well as virtual participants by sharing your opinion in the comment section!

TCTAP A-069

Evaluation of Instantaneous Wave-Free Ratio and Fractional Flow Reserve in Severe Aortic Valve Stenosis

By Ha Hye Jo, Yeonwoo Choi, Hoyun Kim, Jinho Lee, Do-Yoon Kang, Jung-Min Ahn, Duk-Woo Park, Seung-Jung Park

Presenter

Hahye Jo

Authors

Ha Hye Jo1, Yeonwoo Choi1, Hoyun Kim1, Jinho Lee1, Do-Yoon Kang1, Jung-Min Ahn1, Duk-Woo Park1, Seung-Jung Park1

Affiliation

Asan Medical Center, Korea (Republic of)1
View Study Report
TCTAP A-069
Physiologic Lesion Assessment

Evaluation of Instantaneous Wave-Free Ratio and Fractional Flow Reserve in Severe Aortic Valve Stenosis

Ha Hye Jo1, Yeonwoo Choi1, Hoyun Kim1, Jinho Lee1, Do-Yoon Kang1, Jung-Min Ahn1, Duk-Woo Park1, Seung-Jung Park1

Asan Medical Center, Korea (Republic of)1

Background

The appropriate intracoronary physiology assessment for coronary artery stenosis in patients with severe aortic stenosis(AS) has not been established. We compared the instantaneous wave free ratio (iFR) with fractional flow reserve (FFR) in patients with or without severe aortic valve stenosis and assessed their prognostic values.

Methods

We identified 310 lesions in 293 patients with severe AS (trans-aortic maximal velocity >4.0 m/s) and 2257 lesions in 1822 patients without severe AS from IRIS-FFR registry. iFR and FFR were evaluated to assess the functional significance of coronary stenosis.

Results

iFR ≤0.89 was observed in 66.6% of the severe AS group and 31.8% of the no severe AS group (P<0.001), while FFR ≤0.80 was 45.3% and 43.9% in severe AS group and no severe AS group(P=0.60), respectively. At given stenoses, the proportion of iFR≤0.89 was significantly higher in severe AS group than no severe AS group (82.2% vs.48.3%, 56.4% vs. 24.1% for diameter stenosis (DS) >70%, and 50-70%,respectively, all P<0.001) while there was no significant difference in the proportion of FFR≤0.80 between severe AS and no severe AS group (71.1% vs.68.4%, 31.0% vs. 32.7% for DS>70%, and 50-70%, respectively, all P>0.05). In addition, the substantially distinct discordant patterns were observed : iFR-positive discordance (iFR≤0.89 and FFR>0.8) was more prevalent than iFR-negative discordance (iFR>0.89 and FFR≤0.8) in severe AS group (24.2%vs. 1.6%) while the opposite was observed in no severe AS group (5.4% vs. 17.5%). During a median follow-up of 2.0 years (interquartile range: 0.8 to 3.4),iFR≤0.89 had no prognostic value (adjusted hazard ratio [aHR], 1.03; 95%confidence interval [CI], 0.40-2.68; P=0.95) while FFR≤0.80 was significantly associated with deferred lesion failure (aHR, 2.82; 95% CI, 1.07-7.40;P=0.036).

Conclusion

This study suggested that iFR guided decision may overestimate the functional severity of coronary artery disease without prognostic significance, and thus carry the risk of unnecessary revascularization in patients with severe AS.

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