Five years of evidence: impact of aortic stenosis severity on angiography-derived QFR before and after TAVI

Background Transcatheter aortic valve implantation (TAVI) results in a significant reduction of transvalvular gradients, which may influence coronary hemodynamics. Whether the severity of aortic stenosis affects angiography-derived coronary physiology remains uncertain. We investigated the impact of baseline aortic stenosis severity on paired Quantitative Flow Ratio (QFR) measurements obtained before and after TAVI. Methods This retrospective single-centre study included patients undergoing TAVI between October 2020 and September 2025 with available paired pre- and post-procedural invasive coronary angiographies. QFR was computed retrospectively using Medis QFR® 3.0. Only post-TAVI angiographies performed within six months were included. Vessel-level QFR values were compared before and after TAVI. Exploratory analyses were performed according to baseline hemodynamic severity. Results A total of 56 patients with paired pre- and post-TAVI coronary angiographies were included in the analysis. The median age at the time of TAVI was 82.0 [78.0 - 86.0] years. The median interval between baseline coronary angiography and TAVI was 4.0 [2.0 - 31.0] days, while the interval between TAVI and follow-up angiography was 57.0 [12.0 - 103.0] days. Baseline hemodynamic assessment revealed a median peak transvalvular gradient of 61.0 [40.0 - 79.3] mmHg and a median mean gradient of 36.0 [25.0-49.0] mmHg, reflecting a heterogeneous severe aortic stenosis population. Following valve implantation, gradients decreased substantially to 17.0 [11.0 - 23.0] mmHg and 9.0 [6.0 - 12.0] mmHg, respectively. (Table 1). Of 336 screened vessels, 81 (24.1%) were excluded due to overlap, tortuosity, occlusion, missing projections, or wire artefacts. Median ΔQFR values were comparable between groups, with no statistically significant differences in any coronary territory (left anterior descending artery p=0.314, left circumflex artery p=0.845, right coronary artery p=0.601) (Table 2). Conclusions Despite substantial reductions in transvalvular gradients, angiography-derived coronary physiology assessed by QFR remained stable across the TAVI timeline. Baseline severity of aortic stenosis did not translate into systematic changes in QFR following valve intervention. These findings suggest that coronary lesion assessment using QFR may be accurate and clinically applicable prior to valve intervention. Prospective studies are warranted to confirm these observations.