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Review
Functional assessment of coronary artery disease in patients with severe aortic stenosis: a review
  1. Eron Yones1,2,
  2. Julian Gunn1,2,
  3. Javaid Iqbal1,2,
  4. Paul D Morris1,2
  1. 1 School of Clinical Medicine and Population Health, The University of Sheffield, Sheffield, UK
  2. 2 Directorate of Cardiology and Cardiothoracic Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
  1. Correspondence to Dr Eron Yones; eron.yones2{at}nhs.net

Abstract

A significant proportion of patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI) have concomitant coronary artery disease (CAD). The best way to treat these patients is contentious. Conventional assessments of ischaemia such as fractional flow reserve (FFR) and instantaneous wave-free ratio are not validated in the context of severe AS despite having a Class I European Society of Cardiology indication in patients with isolated coronary disease. A better understanding of how we assess and interpret coronary physiology in these patients is required to optimise treatment pathways. Only one prospective, randomised trial has investigated the routine use of FFR to guide revascularisation in patients undergoing TAVI and several observational cohort studies have measured changes in hyperaemic and resting indices in patients with severe AS as well as before and after TAVI. The purpose of this review article is to provide a summary of the current data regarding the functional assessment of CAD in patients with severe AS and highlight the current best practice in this evolving area.

  • Aortic Valve Stenosis
  • Transcatheter Aortic Valve Replacement
  • Coronary Vessels
  • Percutaneous Coronary Intervention

https://doi.org/10.1136/heartjnl-2024-324802

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    Footnotes

    • X @drmorriscardio

    • Contributors EY devised the idea for the review article, performed the literature review and wrote the initial draft of the manuscript. PDM, JI and JG have all meticulously reviewed and amended the manuscript over several drafts. EY and PDM have drawn the figures. PDM is the guarantor.

    • Funding PDM was funded by the Wellcome Trust (214567/Z/18/Z). For the purpose of Open Access, the author has applied a CC BY public copyright license to any Author Accepted Manuscript version arising from this submission.This study/research is partly funded by the National Institute for Health and Care Research (NIHR) Sheffield Biomedical Research Centre (NIHR203321*). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.

    • Competing interests None declared.

    • Provenance and peer review Commissioned; externally peer reviewed.