TCT-830 Feasibility and utility of anatomic and physiological evaluation of coronary disease with cardiac ct in severe aortic stenosis (FUTURE-AS registry).

Abstract

Background: Coronary artery disease (CAD) is common in patients with severe aortic stenosis (AS) and may impact transcatheter aortic valve replacement (TAVR) procedural and long-term outcomes. Computed tomography coronary angiography (CTCA) and CT-derived fractional flow reserve (FFRCT) are tools used to assess CAD. However, adoption in the TAVR population is hindered by safety concerns with nitroglycerin and beta-blockers. The safety, accuracy, and utility of CTCA and FFRCT optimized with these medications for TAVR have not been established. Method(s): This international, multicenter, prospective registry included severe AS patients referred for TAVR, assessed for CAD with CTCA and FFRCT. Patients all received nitroglycerin and beta-blockers as needed to optimize image quality. Severe ventricular dysfunction, recent syncope/heart failure, critical hemodynamics, or prior revascularization were excluded. Significant CAD was defined as CTCA stenosis >=50% and FFRCT <=0.75. Primary endpoint was per-patient sensitivity and negative predictive value (NPV) of CTCA compared with invasive coronary angiography (ICA). Secondary endpoints included specificity and positive predictive value (PPV) of CTCA and FFRCT, safety, feasibility (non evaluable rate), and the utility of CTCA+FFRCT to reduce pre-TAVR ICA. Result(s): 327 patients (76 +/- 10 years, 53% men) underwent CTCA. CTCA was safe and well tolerated in nearly all patients, with self-limiting hypotension in 4 (1.2%). CTCA was evaluable in 326 patients (99.7%), with 9 (2.8%) having a non evaluable vessel. FFRCT was performed in 110 (33.6%) and ICA in 133 (40.7%). Per-patient sensitivity, specificity, NPV, and PPV of CTCA were 100%, 71.4%, 100%, and 75.9% and per-vessel 82.7%, 78.9%, 92.3%, and 59.9%. FFRCT improved specificity and PPV to 88.9% and 88.0% for per-patient and 95.1% and 81.8% for per-vessel analysis. Using observed reclassification rates from CTCA and FFRCT, 270 patients (82.6%) could potentially avoid ICA. Conclusion(s): CTCA optimized with nitroglycerin and beta-blockers is safe and effective for assessing CAD in select severe AS patients. Combining CTCA and FFRCT enhances diagnostic accuracy, potentially reducing the need for invasive angiography and streamlining TAVR workup. Categories: STRUCTURAL: Valvular Disease: Aortic.Copyright © 2024