Key result
Preoperative CT-FFR ≤ 0.80 linked to ~4-fold higher risk of death and MACE after AVR.
Why the study?
The role of coronary hemodynamic assessment prior to aortic valve replacement in patients with severe aortic stenosis is not well established.
Does preoperative CT-FFR ≤ 0.80 predict increased risk of adverse cardiac events in patients with severe aortic stenosis undergoing TAVR or SAVR?
Cohort (n=329)
No
Does preoperative CT-FFR ≤ 0.80 predict increased risk of adverse cardiac events in patients with severe aortic stenosis undergoing TAVR or SAVR?
Preoperative CT-FFR ≤ 0.80 is a strong, independent predictor of post-AVR adverse cardiac events in patients with severe aortic stenosis, offering incremental prognostic value over clinical and anatomical models.
Preoperative CT-FFR may refine post-AVR risk stratification in severe AS; leaves open whether routine use improves outcomes.
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.
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Duan et al. (2026) conducted a cohort in Severe aortic stenosis (n=329). CT-FFR ≤ 0.80 vs. CT-FFR > 0.80 was evaluated on Composite of all-cause mortality and major adverse cardiac events (MACE) (HR 3.83, 95% CI 2.04-7.20, p=<0.001). Preoperative CT-FFR ≤ 0.80 was independently associated with a significantly increased risk of the composite endpoint of all-cause mortality and MACE (HR 3.83) after aortic valve replacement.
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