Aortic valve Calcification Scores versus CT-FFR: Prediction of MACE after Transcatheter Aortic Valve Replacement

Introduction:This study aimed to assess the prognostic value of Aortic valve calcification (AVC) score and CT angiography-derived fractional flow reserve (CT-FFR) for major adverse cardiovascular events (MACE) after transcatheter aortic valve replacement (TAVR). Materials: In this retrospective observational cohort study, we included patients with severe aortic valve diseases undergoing TAVR between February 2016 and April 2022. Patients were followed, and univariable and multivariate Cox regression were applied for outcome analysis using a composite endpoint including all-cause mortality, nonfatal myocardial infarction, unstable angina, heart failure rehospitalization. The incremental prognostic value of CT-FFR was also analyzed. Results: A total of 251 patients were enrolled (mean age, 67 ± 10 years; 176 men). During a mean follow-up period of 36 months, 60 patients (23.9%) experienced MACE. AVC score ≥ 2000 (HR = 1.714, 95%CI: 1.020, 2.882, P = 0.042) and CT-FFR ≤ 0.8 (HR = 3.248, 95% CI: 1.760,5.996, P < 0.001) were independent predictors of MACE. The C statistics revealed that adding CT-FFR to the clinical risk factors alone or combined with AVC score provided incremental prognostic value for MACE after TAVR (C-index: 0.710 vs 0.645 [P = 0.012]; and 0.710 vs 0.672 [P = 0.030]). Conclusion: AVC score and CT-FFR were associated with MACE in patients after TAVR, and CT-FFR presented incremental prognostic value for MACE beyond clinical risk factors alone or combined with AVC score. Therefore, CT-FFR should be incorporated into routine clinical decision-making and risk management for TAVR patients.