Coronary CT Fractional Flow Reserve before Transcatheter Aortic Valve                     Replacement: Clinical Outcomes

Aquino, Gilberto; Abadia, Andres F.; Schoepf, U. Joseph; Emrich, Tilman; Yacoub, Basel; Kabakus, Ismail; Violette, Alexis; Wiley, Courtney; Moreno, Andreina; Sahbaee, Pooyan; Schwemmer, Chris; Bayer, Richard R.; Varga-Szemes, Ákos; Steinberg, Daniel; Amoroso, Nicholas; Kocher, Madison; Waltz, Jeffrey; Ward, Thomas J.; Burt, Jeremy R.

doi:10.1148/radiol.2021210160

Cited by 13 publications

(9 citation statements)

References 30 publications

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“…An increasing number of studies are focusing on the utility of CT–FFR in the context of CTA evaluation before TAVI [ 24 , 25 , 26 , 27 , 28 ]. Table 2 provides an overview of relevant research articles with this focus.…”

Section: Overview Of the Current Literaturementioning

confidence: 99%

“…Aquino et al [ 27 ] reported clinical outcomes from their retrospective study on the role of CT–FFR in pre-TAVI work-up. In total, 196 patients were included.…”

Section: Overview Of the Current Literaturementioning

confidence: 99%

“…The feasibility of coronary artery assessment with CTA in a subset of patients scheduled for TAVI has been established previously and based on further development in the field of CT technology, with improved spatial and temporal resolution, its potential value has been suggested [ 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 ]. Only recently, the addition of computational fluid dynamic-based and machine learning (ML)-based solutions for fractional flow reserve from CTA (CT–FFR) showed the potential to improve the diagnostic performance of CTA before TAVI [ 24 , 25 , 26 , 27 , 28 ]. However, the utilization of CTA for coronary artery evaluation remains limited in this specific population of patients due to the relatively high risk of CAD concomitant with severe AS and the present guideline statement.…”

Section: Introductionmentioning

confidence: 99%

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Combined CT Coronary Artery Assessment and TAVI Planning

2023

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Computed tomography angiography (CTA) of the aorta and the iliofemoral arteries is crucial for preprocedural planning of transcatheter aortic valve implantation (TAVI) in patients with severe aortic stenosis (AS), because it provides details on a variety of aspects required for heart team decision-making. In addition to providing relevant diagnostic information on the degree of aortic valve calcification, CTA allows for a customized choice of the transcatheter heart valve system and the TAVI access route. Furthermore, current guidelines recommend the exclusion of relevant coronary artery disease (CAD) prior to TAVI. The feasibility of coronary artery assessment with CTA in patients scheduled for TAVI has been established previously, and accumulating data support its value. In addition, fractional flow reserve determined from CTA (CT–FFR) and machine learning-based CT–FFR were recently shown to improve its diagnostic yield for this purpose. However, the utilization of CTA for coronary artery evaluation remains limited in this specific population of patients due to the relatively high risk of CAD coexistence with severe AS. Therefore, the current diagnostic work-up prior to TAVI routinely includes invasive catheter coronary angiography at most centers. In this article, the authors address technological prerequisites and CT protocol considerations, discuss pitfalls, review the current literature regarding combined CTA coronary artery assessment and preprocedural TAVI evaluation, and provide an overview of unanswered questions and future research goals within the field.

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Section: Overview Of the Current Literaturementioning

confidence: 99%

“…Aquino et al [ 27 ] reported clinical outcomes from their retrospective study on the role of CT–FFR in pre-TAVI work-up. In total, 196 patients were included.…”

Section: Overview Of the Current Literaturementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Combined CT Coronary Artery Assessment and TAVI Planning

2023

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“…CT-FFR may be a potential tool for evaluating the function of patients with congenital coronary origin abnormalities [78][79][80] Patients with pre-TAVR CT-FFR can effectively exclude coronary heart disease in pre-TAVR patients and reduce the ICA examination rate in elderly patients 81 CT-FFR can predict MACE in candidates for TAVR 82 Patients with onset/stable chest pain (30%-70% stenosis)…”

Section: Patients With Congenital Coronary Origin Abnormalitiesmentioning

confidence: 99%

“…The diagnostic performance of CT-FFR on bifurcation, severe tortuosity, tandem lesions, extensive diffuse lesions, microvascular disease, ostial stenosis, and heavy calcification have also not been fully evaluated (Table 1). 18–20,23,24,26,28,29,53–58,66–89…”

Section: Indications Of Ct-ffrmentioning

confidence: 99%

Coronary Computed Tomography Angiography–derived Fractional Flow Reserve

Zhang

Tang

et al. 2022

Journal of Thoracic Imaging

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Invasive fractional flow reserve (FFR) measured by a pressure wire is a reference standard for evaluating functional stenosis in coronary artery disease. Coronary computed tomography angiography-derived fractional flow reserve (CT-FFR) uses advanced computational analysis methods to noninvasively obtain FFR results from a single conventional coronary computed tomography angiography data to evaluate the hemodynamic significance of coronary artery disease. More and more evidence has found good correlation between the results of noninvasive CT-FFR and invasive FFR. CT-FFR has proven its potential in optimizing patient management, improving risk stratification and prognosis, and reducing total health care costs. However, there is still a lack of standardized interpretation of CT-FFR technology in real-world clinical settings. This expert consensus introduces the principle, workflow, and interpretation of CT-FFR; summarizes the stateof-the-art application of CT-FFR; and provides suggestions and recommendations for the application of CT-FFR with the aim of promoting the standardized application of CT-FFR in clinical practice.

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