CT-FFR demonstrated good diagnostic performance for detecting haemodynamically significant CAD in TAVI candidates, with sensitivity 80.9%, specificity 93.5%, and diagnostic accuracy 88.5%, suggesting integration into routine workflows may reduce purely diagnostic invasive procedures while maintaining accuracy.
CT-FFR demonstrated good overall diagnostic performance for identifying functionally significant coronary artery disease in TAVI candidates on a per-vessel basis.
CT-FFR successfully analysed all 52 vessels in the final cohort of 37 patients, with a mean CT-FFR value of 0.86 ± 0.11.
A clinically relevant proportion of initially screened patients were excluded due to insufficient CT image quality, representing a limitation of clinical feasibility.
The study population consisted of elderly patients with severe aortic stenosis, and CAD was prevalent among them.
Short-term clinical outcomes at 30 days post-TAVI were favourable, with no major adverse cardiovascular events observed.
This research suggests that a non-invasive technique called CT-derived fractional flow reserve (CT-FFR) can accurately identify whether coronary arteries are significantly blocked in patients with severe aortic valve disease who are being considered for a minimally invasive valve replacement procedure called TAVI. Rather than requiring a separate invasive heart procedure to check the coronary arteries, CT-FFR uses the CT scan already performed as part of TAVI planning to generate a functional assessment of blood flow. In this study of 37 elderly patients (average age 79), CT-FFR correctly identified significant coronary blockages about 81% of the time and correctly ruled out non-significant blockages about 94% of the time, with an overall accuracy of nearly 89%. An important practical limitation identified was that about 13% of patients screened could not be analysed because their CT images were not of sufficient quality, meaning this approach would not work for everyone. Additionally, all patients remained free from death, heart attack, or stroke at 30 days after their procedure, suggesting the overall management strategy was safe. The findings indicate that CT-FFR could potentially reduce the need for purely diagnostic invasive coronary angiography procedures in this patient group, which matters because TAVI patients are often elderly and at higher risk from additional invasive tests. This research suggests that incorporating CT-FFR into routine TAVI planning workflows is feasible and could streamline care, but the authors caution that the study was small, retrospective, and conducted at a single centre. Larger prospective studies are needed before this approach can be more widely recommended in clinical practice.
Aksüyek S, Koca F, Arslan A, Demir M, Melek M, Arı H, et al.. (2026). Diagnostic performance of computed tomography-derived fractional flow reserve in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation: a single-centre feasibility study.. Cardiovascular journal of Africa. https://doi.org/10.5830/CVJA-2026-032