In this study it is aimed to determine the diagnostic value of physiological measurements in the presence of aortic stenosis, and whether these are more accurate than angiographic assessment. Post-TAVR FFR will be taken as the reference for predicting ischemic lesions, and angiography and physiology - FFR and diastolic pressure ratio (dPR) - will be performed immediately before and after TAVR, in an all-comer multicentric observational study.
This is a post-marketing, prospective, observational, single arm, multi-center, single country study in Subjects who have severe symptomatic aortic stenosis with a formal indication for TAVR, and one or more intermediate coronary lesions in a relevant coronary artery (\>2mm). This study aims to assess if OpSens non-hyperemic dPR (based on a proprietary algorithm) and/or OpSens FFR are suitable methods for the physiological assessment and prediction of ischemic coronary lesions in Subjects with aortic stenosis who are considered for TAVR. This will be done by comparing pre-TAVR measurements of angiography, dPR and FFR and placing them against the post-TAVR FFR, which is considered as the gold standard. Also the post TAVR dPR will be compared with post-TAVR FFR. A maximum of 137 subjects will be enrolled in 5 to 10 sites in Spain to obtain the required minimum of 137 lesions (see section 11.2 Sample Size Determination) The main hypothesis is that the specificity to predict ischemic lesions in TAVR candidates based on a pre-TAVR dPR ≤ 0.89 is superior compared to the specificity based on angiography alone (both QCA and visual assessment of the stenosis \>50%), taking the post-TAVR FFR value of ≤ 0.80 as a reference for positive lesions. The pressure guidewire used to measure dPR and FFR during diagnostic angiography is the commercially available (CE-marketed) OptoWire family of pressure guidewires from OpSens Inc.
Study Type
OBSERVATIONAL
Enrollment
32
OpSens non-hyperemic dPR and/or OpSens FFR
Hospital Universitari Germans Trias i Pujol
Badalona, Spain
Hospital Gregorio Maranon
Madrid, Spain
Hospital Virgen de la Victoria
Málaga, Spain
Hospital Clinico de Santiago
Santiago de Compostela, Spain
Difference between preTAVR dPR specificity and angiography specificity for ischemia
The difference between PreTAVR dPR specificity (%) - angiography specificity (%), taking post-TAVR FFR as the reference measure.
Time frame: Immediately upon completion of the TAVR procedure
Diagnostic accuracy
Establish sufficiently precise estimates (+/- 6.5% around estimate) for the diagnostic accuracy of pre-TAVR dPR expressed in terms of sensitivity and specificity, taking as the reference for ischemia the post-TAVR FFR
Time frame: Immediately upon completion of the TAVR procedure
Difference in accuracy between dPR and angiography
The difference between the percentage of lesions correctly classified by preTAVR dPR and the percentage of lesions correctly classified by angiography, always taking postTAVR FFR as the reference measure.
Time frame: Immediately upon completion of the TAVR procedure
Difference in sensitivity between dPR and angiography
The difference between the sensitivity of preTAVR dPR and the sensitivity of angiography, where: 1. preTAVR sensitivity= preTAVR True positive/ (preTAVR true positive+ preTAVR false negative) \* 100 2. angiography sensitivity= angiography True positive/ (angiography true positive+ angiography false negative) \* 100, taking post-TAVR FFR as the reference measure.
Time frame: Immediately upon completion of the TAVR procedure
Predicting post-TAVR FFR by pre-TAVR FFR
Overall diagnostic accuracy of preTAVR FFR, defined as the percentage of lesions correctly classified by pre-TAVR FFR, taking postTAVR FFR as the reference measure.
Time frame: Immediately upon completion of the TAVR procedure
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Hospital Clinico Universitario de Valladolid
Valladolid, Spain
Difference in accuracy between preTAVR dPR and preTAVR FFR
The difference in the overall diagnostic accuracy of pre-TAVR dPR and pre-TAVR FFR to predict a post-TAVR FFR ≤ 0.80
Time frame: Immediately upon completion of the TAVR procedure
Predicting post-TAVR FFR by pre-TAVR hybrid dPR-FFR
Overall diagnostic accuracyof a pre-TAVR hybrid dPR-FFR based approach to predict a post-TAVR FFR ≤ 0.80
Time frame: Immediately upon completion of the TAVR procedure