[Measurement of fractional flow reserve in patients with severe aortic stenosis: A valid test?]
A 54-year-old woman was hospitalized for an acute pulmonary oedema revealing a severe aortic stenosis (AS) associated with an aortic aneurysm and a left ventricular hypertrophy (LVH). The coronary angiography found an equivocal left main lesion. Fractional flow reserve (FFR) showed hemodynamic significance (FFR=0.78) and optical coherence tomography confirmed this result with a minimal lumen area of 4.9mm2. FFR-guided percutaneous intervention is reported to improve outcome in patients with stable coronary disease. However, only few data are available in cases of AS. In this condition, secondary LVH is associated with microcirculatory dysfunction, which interferes with optimal hyperemia. An elevated right atrial pressure could also modify FFR measurement. This risk of underestimation of a coronary lesion in patients with severe AS has to be taken into consideration in clinical practice.
Service de cardiologie, centre hospitalier intercommunal Le Raincy Montfermeil, rue du Général-Leclerc, 93370 Montfermeil, France.
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Kikoïne
Service de cardiologie, centre hospitalier intercommunal Le Raincy Montfermeil, rue du Général-Leclerc, 93370 Montfermeil, France.
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Lebon
Service de cardiologie, centre hospitalier intercommunal Le Raincy Montfermeil, rue du Général-Leclerc, 93370 Montfermeil, France.
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Gouffran
Service de cardiologie, centre hospitalier intercommunal Le Raincy Montfermeil, rue du Général-Leclerc, 93370 Montfermeil, France.
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Millischer
Service de cardiologie, centre hospitalier intercommunal Le Raincy Montfermeil, rue du Général-Leclerc, 93370 Montfermeil, France.
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Cattan
Service de cardiologie, centre hospitalier intercommunal Le Raincy Montfermeil, rue du Général-Leclerc, 93370 Montfermeil, France. Electronic address: olivierparisnallet@gmail.com.
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Nallet
D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery; D001705:Bioprosthesis; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery; D005260:Female; D053805:Fractional Flow Reserve, Myocardial / Q000502:physiology*; D019918:Heart Valve Prosthesis Implantation; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery; D008875:Middle Aged; D009204:Myocardial Revascularization; D011654:Pulmonary Edema / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D012307:Risk Factors; D041623:Tomography, Optical Coherence
Aortic stenosis; Coronary reserve; Coronary stenosis; FFR; Fractional flow reserve; Heart failure; Hypertrophie ventriculaire gauche; Insuffisance cardiaque; Microcirculation; Réserve coronaire; Rétrécissement aortique; Sténose coronaire; Ventricular hypertropy