Variation of computed tomographic angiography–based fractional flow reserve after transcatheter aortic valve implantation

Objectives We sought to identify the impact of transcatheter aortic valve implantation (TAVI) on changes of fractional flow reserve computed tomography (FFR CT ) values and the associated clinical impact. Methods A retrospective analysis was done with CT obtained pre-TAVI, prior to hospital discharge and at 1-year follow-up, which provided imaging sources for the calculation of FFR CT values based on an online platform. Results A total of 190 patients were enrolled. Patients with pre-procedural FFR CT value > 0.80 (i.e., negative) and ≤ 0.80 (i.e., positive) demonstrated a significantly opposite change in the value after TAVI (0.8798 vs. 0.8718, p < 0.001 and 0.7634 vs. 0.8222, p < 0.001, respectively). The history of coronary artery disease (CAD) was identified as an independent predictor for FFR CT changing from negative to positive after TAVI (odds ratio [OR] 2.927, 95% confidence interval [CI] 1.130–7.587, p = 0.027), with lesions more severely stenosed (OR 1.039, 95% CI 1.003–1.076, p = 0.034) and in left anterior descending coronary artery (LAD) (OR 3.939, 95% CI 1.060–14.637, p = 0.041) being prone to change. Conclusions TAVI directly brings improvement in FFR CT values in patients with compromised coronary flow. Patients with a history of CAD, especially with lesions more severely stenosed and in LAD, were under risk of FFR CT changing from negative to positive after TAVI. Key Points • The effect of TAVI on coronary hemodynamics might be influenced by different ischemic severity and coronary territories reflected by FFR CT values. • As different FFR CT variations did not impact outcomes of TAVI patients, AS, but not coronary issues, may be the primary problem to affect, which needs further validation.