Feasibility and Comparison of Resting Full-Cycle Ratio and Computed Tomography Fractional Flow Reserve in Patients with Severe Aortic Valve Stenosis

Wienemann, Hendrik; Langenbach, Marcel C.; Mauri, Victor; Banazadeh, Maryam; Klein, Konstantin; Hohmann, Christopher; Lee, Samuel; Breidert, Isabel; Hof, Alexander; Eghbalzadeh, Kaveh; Kuhn, Elmar; Halbach, Marcel; Maintz, David; Baldus, Stephan; Bunck, Alexander; Adam, Matti

doi:10.3390/jcdd9040116

Open AccessArticle

Feasibility and Comparison of Resting Full-Cycle Ratio and Computed Tomography Fractional Flow Reserve in Patients with Severe Aortic Valve Stenosis

by

Hendrik Wienemann

^1,*,†

,

Marcel C. Langenbach

^2,†,

Victor Mauri

¹,

Maryam Banazadeh

¹

,

Konstantin Klein

²,

Christopher Hohmann

¹,

Samuel Lee

¹,

Isabel Breidert

¹,

Alexander Hof

¹

,

Kaveh Eghbalzadeh

³,

Elmar Kuhn

³,

Marcel Halbach

¹,

David Maintz

²,

Stephan Baldus

¹,

Alexander Bunck

^2,‡ and

Matti Adam

^1,‡

¹

Clinic III for Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 61, 50937 Cologne, Germany

²

Department of Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 61, 50937 Cologne, Germany

³

Department of Cardiothoracic Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 61, 50937 Cologne, Germany

^*

Author to whom correspondence should be addressed.

^†

Hendrik Wienemann and Marcel C. Langenbach contributed equally and share the first authorship of this work.

^‡

Matti Adam and Alexander Bunck jointly co-directed this work and share the last authorship of this work.

J. Cardiovasc. Dev. Dis. 2022, 9(4), 116; https://doi.org/10.3390/jcdd9040116

Submission received: 16 March 2022 / Revised: 10 April 2022 / Accepted: 12 April 2022 / Published: 14 April 2022

(This article belongs to the Special Issue Transcatheter Aortic Valve Implantation (TAVI))

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Abstract

Background: Computed tomography derived Fractional Flow Reserve (CT-FFR) has been shown to decrease the referral rate for invasive coronary angiography (ICA). The purpose of the study was to evaluate the diagnostic performance of CT-FFR compared to hyperemia-free index Resting Full-cycle Ratio (RFR) in patients with relevant aortic stenosis (AS) and intermediate coronary stenosis. Methods: 41 patients with 46 coronary lesions underwent ICA with quantitative coronary angiography (QCA), pressure wire assessment and routine pre-transcatheter aortic valve replacement (TAVR) computed tomography (CT). CT-FFR analysis was performed using prototype on-site software. Results: RFR showed a significant correlation with CT-FFR (Pearson’s correlation, r = 0.632, p < 0.001). On a per-lesion basis, diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of CT-FFR were 82.6% (95% CI 68.6–92.2), 69.6% (95% CI 47.1–86.8), 95.7% (95% CI 78.1–99.9), 94.1% (95% CI 69.8–99.1), and 75.9% (95% CI 62.7–85.4), respectively. The optimal cutoff value of the CT-FFR for RFR ≤ 0.89 prediction was 0.815. The area under the receiver curve showed a larger area under the curve for CT-FFR (0.87; 95% CI 0.75–0.98) compared with CTA stenosis of ≥50% (0.54, 95% CI 0.38–0.71), CTA ≥ 70% (0.72, 95% CI 0.57–0.87) and QCA ≥ 50% (0.67, 95% CI 0.52–0.83). Conclusions: CT-FFR assessed by routine pre-TAVR CT is safe and feasible and shows a significant correlation with RFR in patients with AS. CT-FFR is superior to QCA ≥ 50%, CT ≥ 50% and CT ≥ 70% in assessing the hemodynamic relevance of intermediate coronary lesions. Thus, CT-FFR has the potential to guide revascularization in patients with AS.

Keywords: coronary artery disease; computed tomography fractional flow reserve; invasive coronary angiography; resting full-cycle ratio; aortic valve stenosis

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MDPI and ACS Style

Wienemann, H.; Langenbach, M.C.; Mauri, V.; Banazadeh, M.; Klein, K.; Hohmann, C.; Lee, S.; Breidert, I.; Hof, A.; Eghbalzadeh, K.; et al. Feasibility and Comparison of Resting Full-Cycle Ratio and Computed Tomography Fractional Flow Reserve in Patients with Severe Aortic Valve Stenosis. J. Cardiovasc. Dev. Dis. 2022, 9, 116. https://doi.org/10.3390/jcdd9040116

AMA Style

Wienemann H, Langenbach MC, Mauri V, Banazadeh M, Klein K, Hohmann C, Lee S, Breidert I, Hof A, Eghbalzadeh K, et al. Feasibility and Comparison of Resting Full-Cycle Ratio and Computed Tomography Fractional Flow Reserve in Patients with Severe Aortic Valve Stenosis. Journal of Cardiovascular Development and Disease. 2022; 9(4):116. https://doi.org/10.3390/jcdd9040116

Chicago/Turabian Style

Wienemann, Hendrik, Marcel C. Langenbach, Victor Mauri, Maryam Banazadeh, Konstantin Klein, Christopher Hohmann, Samuel Lee, Isabel Breidert, Alexander Hof, Kaveh Eghbalzadeh, and et al. 2022. "Feasibility and Comparison of Resting Full-Cycle Ratio and Computed Tomography Fractional Flow Reserve in Patients with Severe Aortic Valve Stenosis" Journal of Cardiovascular Development and Disease 9, no. 4: 116. https://doi.org/10.3390/jcdd9040116

APA Style

Wienemann, H., Langenbach, M. C., Mauri, V., Banazadeh, M., Klein, K., Hohmann, C., Lee, S., Breidert, I., Hof, A., Eghbalzadeh, K., Kuhn, E., Halbach, M., Maintz, D., Baldus, S., Bunck, A., & Adam, M. (2022). Feasibility and Comparison of Resting Full-Cycle Ratio and Computed Tomography Fractional Flow Reserve in Patients with Severe Aortic Valve Stenosis. Journal of Cardiovascular Development and Disease, 9(4), 116. https://doi.org/10.3390/jcdd9040116

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Feasibility and Comparison of Resting Full-Cycle Ratio and Computed Tomography Fractional Flow Reserve in Patients with Severe Aortic Valve Stenosis

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