Early changes in CT-derived quantitative flow ratio after transcatheter aortic valve replacement: a serial coronary physiological assessment

Aims Transcatheter aortic valve replacement (TAVR) is an established treatment for severe aortic valve stenosis, but its effects on coronary physiology remain incompletely understood. CT-derived quantitative flow ratio (CT-QFR) enables non-invasive assessment of coronary physiology. This study aimed to investigate the early changes in CT-QFR following TAVR. Methods This retrospective study included consecutive patients with severe aortic stenosis who underwent coronary computed tomography angiography before and within 7 days after TAVR. CT-QFR was calculated for all analyzable coronary vessels. Longitudinal changes in CT-QFR were evaluated using linear mixed-effects models with patient identifier as a random effect. Results A total of 109 patients (324 coronary vessels) were analyzed. Plaque volume, plaque burden, and minimal lumen diameter remained unchanged after TAVR, whereas transvalvular pressure gradients decreased significantly. Overall, CT-QFR increased modestly following TAVR ( β =0.018, P < 0.001). Significant increases were observed in the left anterior descending and right coronary arteries, whereas no significant change was detected in the left circumflex artery. Vessels with baseline %DS ≥50% demonstrated greater CT-QFR increases than those with less severe stenosis (interaction β =0.104, P < 0.001). Likewise, vessels with baseline CT-QFR <0.80 showed significantly larger post-TAVR increases than vessels with baseline CT-QFR ≥0.80 (interaction β =0.117, P < 0.001). Conclusion TAVR was associated with modest early increases in CT-QFR, particularly in vessels with greater anatomical stenosis or baseline physiological impairment. These findings suggest that coronary physiological assessment in severe aortic stenosis may be influenced by valve intervention and should be interpreted cautiously during the peri-TAVR period.