Prognostic value of preoperative CT-derived fractional flow reserve after transcatheter or surgical aortic valve replacement in patients with severe aortic stenosis.
Authors
Affiliations (6)
Affiliations (6)
- Department of Radiology, The Affiliated Yan'an Hospital of Kunming Medical University (Kunming Yan'an Hospital), Kunming, 650051, China.
- Yan'an Hospital Affiliated to Kunming Medical University (Kunming Yan'an Hospital), Key Laboratory of Cardiovascular Disease of Yunnan Province, Kunming, 650051, China.
- Department of Radiology, The Affiliated Yan'an Hospital of Kunming Medical University (Kunming Yan'an Hospital), Kunming, 650051, China. [email protected].
- Yan'an Hospital Affiliated to Kunming Medical University (Kunming Yan'an Hospital), Key Laboratory of Cardiovascular Disease of Yunnan Province, Kunming, 650051, China. [email protected].
- Department of Radiology, The Affiliated Yan'an Hospital of Kunming Medical University (Kunming Yan'an Hospital), Kunming, 650051, China. [email protected].
- Yan'an Hospital Affiliated to Kunming Medical University (Kunming Yan'an Hospital), Key Laboratory of Cardiovascular Disease of Yunnan Province, Kunming, 650051, China. [email protected].
Abstract
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). 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). 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. 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.