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Background <p>Patients with aortic stenosis (AS) often have concomitant coronary artery disease (CAD), and coronary CTA (CCTA) is performed for anatomical evaluation to inform coronary revascularization decision-making prior to aortic valve replacement (AVR). However, the role of coronary hemodynamic assessment in pre-AVR is not well established. We aim to evaluate the prognostic value of preoperative CT angiography–derived fractional flow reserve (CT-FFR) in patients with severe AS undergoing transcatheter (TAVR) or surgical aortic valve replacement (SAVR).</p> Methods <p>This consecutive retrospective observational cohort (July 2023–January 2025) included patients with severe AS referred to TAVR or SAVR. CT-FFR was obtained fully-automatic using an on-site machine learning algorithm, and a low value was defined as CT-FFR ≤ 0.80. The composite endpoint was a patient-oriented composite of all-cause mortality and major adverse cardiac events (MACE) (nonfatal myocardial infarction, unstable angina, cardiac death, cardiovascular-driven admission or heart failure admission).</p> Results <p>Among 329 patients (mean age 61.4 ± 13.1 years), composite endpoint occurred in 14.3% and all-cause mortality in 4.0% over a median follow-up of 17 months. After adjustment, CT-FFR ≤ 0.80 remained independently associated with the composite endpoint (HR 3.83; 95% CI 2.04–7.20; <i>P</i> &lt; 0.001) and with MACE (HR 4.84; 95% CI 2.40–9.78; <i>P</i> &lt; 0.001), but was not independently associated with all-cause mortality (<i>P</i> = 0.071). Adding CT-FFR to clinical models substantially improved risk discrimination for MACE (C-index 0.74) and significantly improved reclassification (NRI 0.346; <i>P</i> &lt; 0.001), whereas adding anatomical CCTA alone provided minimal incremental value.</p> Conclusion <p>In patients with severe AS undergoing TAVR or SAVR, preoperative CT-FFR was associated with an increased risk of post-AVR adverse cardiac events. The prognostic value of CT-FFR was consistent across both TAVR and SAVR populations and may improve individual-level risk reclassification.</p> Graphical Abstract <p></p>

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Prognostic value of preoperative CT-derived fractional flow reserve after transcatheter or surgical aortic valve replacement in patients with severe aortic stenosis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月8日

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  • Xirui Duan,
  • Xudong Jin,
  • Shiying Tang,
  • Shuaiyan Zuo,
  • Wan Shen,
  • Lei Yang,
  • Ting Yang,
  • Xiaolan Du,
  • Feifei Zhou,
  • Xinyan Zhou,
  • Rong Qian,
  • Na Tan,
  • Guifang Sun,
  • Chengde Liao

摘要

Background

Patients with aortic stenosis (AS) often have concomitant coronary artery disease (CAD), and coronary CTA (CCTA) is performed for anatomical evaluation to inform coronary revascularization decision-making prior to aortic valve replacement (AVR). However, the role of coronary hemodynamic assessment in pre-AVR is not well established. We aim to evaluate the prognostic value of preoperative CT angiography–derived fractional flow reserve (CT-FFR) in patients with severe AS undergoing transcatheter (TAVR) or surgical aortic valve replacement (SAVR).

Methods

This consecutive retrospective observational cohort (July 2023–January 2025) included patients with severe AS referred to TAVR or SAVR. CT-FFR was obtained fully-automatic using an on-site machine learning algorithm, and a low value was defined as CT-FFR ≤ 0.80. The composite endpoint was a patient-oriented composite of all-cause mortality and major adverse cardiac events (MACE) (nonfatal myocardial infarction, unstable angina, cardiac death, cardiovascular-driven admission or heart failure admission).

Results

Among 329 patients (mean age 61.4 ± 13.1 years), composite endpoint occurred in 14.3% and all-cause mortality in 4.0% over a median follow-up of 17 months. After adjustment, CT-FFR ≤ 0.80 remained independently associated with the composite endpoint (HR 3.83; 95% CI 2.04–7.20; P < 0.001) and with MACE (HR 4.84; 95% CI 2.40–9.78; P < 0.001), but was not independently associated with all-cause mortality (P = 0.071). Adding CT-FFR to clinical models substantially improved risk discrimination for MACE (C-index 0.74) and significantly improved reclassification (NRI 0.346; P < 0.001), whereas adding anatomical CCTA alone provided minimal incremental value.

Conclusion

In patients with severe AS undergoing TAVR or SAVR, preoperative CT-FFR was associated with an increased risk of post-AVR adverse cardiac events. The prognostic value of CT-FFR was consistent across both TAVR and SAVR populations and may improve individual-level risk reclassification.

Graphical Abstract