Related Experiment Video
Updated: Jul 15, 2026
Improved Registration of 3D CT Angiography with X-ray Fluoroscopy for Image Fusion During Transcatheter Aortic Valve Implantation
Published on: June 3, 2018
Diagnostic performance of angiography-derived coronary physiology in transcatheter aortic valve implantation pathway:
Ioannis Skalidis1, Lisa Simioni2, Giulia S Beretta2
1Department of Cardiology, HFR - Fribourg Cantonal Hospital and University, Fribourg, Switzerland; Institut Cardiovasculaire Paris-Sud, Hôpital Jacques Cartier, Massy, France.
Insights
Angiography-derived coronary physiology accurately detects significant coronary stenoses in transcatheter aortic valve implantation (TAVI) candidates. Its diagnostic performance is comparable whether fractional flow reserve (FFR) is measured before or after TAVI.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Imaging
Background:
- Coronary artery disease (CAD) is prevalent in patients undergoing transcatheter aortic valve implantation (TAVI).
- Accurate assessment of coronary stenosis significance is crucial for guiding management in TAVI candidates.
- The diagnostic utility of non-invasive, angiography-derived coronary physiology for detecting significant stenoses in this population remains under investigation.
Purpose of the Study:
- To evaluate the diagnostic performance of angiography-derived coronary physiology for identifying significant coronary artery stenoses (defined by invasive fractional flow reserve [FFR] ≤0.80) in patients evaluated for TAVI.
- To assess if the diagnostic accuracy of angiography-derived physiology differs when invasive FFR is measured before versus after TAVI.
Main Methods:
- A diagnostic accuracy meta-analysis was conducted, including studies comparing lesion-level angiography-derived physiology (quantitative flow ratio [QFR]) against invasive FFR (≤0.80).
- Pooled sensitivity, specificity, and diagnostic odds ratios (DOR) were calculated using random-effects models.
- Meta-regression analysis explored the impact of the timing of invasive FFR measurement (pre- vs. post-TAVI).
Main Results:
- Five studies with 422 to 250 lesions were included in the analyses.
- The pooled sensitivity for detecting significant stenoses was 0.79 (95% CI, 0.68-0.87) and specificity was 0.88 (95% CI, 0.80-0.93).
- Diagnostic performance remained comparable regardless of whether FFR was measured before or after TAVI (P = .39 for interaction).
Conclusions:
- Angiography-derived coronary physiology demonstrates good diagnostic accuracy in TAVI candidates.
- The method provides reliable assessment of coronary stenosis significance, with consistent performance irrespective of FFR measurement timing relative to TAVI.
- Interpretation requires consideration of potential hemodynamic instability affecting reference standards.
Objectives:
Coronary artery disease affects nearly half of patients undergoing transcatheter aortic valve implantation (TAVI), but the accuracy of angiography-derived, wire-free coronary physiology in severe aortic stenosis remains uncertain. The authors evaluated its diagnostic performance for detecting fractional flow reserve (FFR)-defined significant stenoses in TAVI candidates and assessed whether accuracy differed when invasive FFR was measured before vs after TAVI.
Methods:
A diagnostic accuracy meta-analysis was performed including studies reporting lesion-level comparisons between angiography-derived physiology (threshold ≤0.80) and invasive FFR (≤0.80) in patients undergoing TAVI evaluation. All included studies evaluated quantitative flow ratio (QFR) or Murray-law-based QFR; no eligible studies using FFRangio or vFFR were identified. Pooled sensitivity and specificity were calculated using random-effects models. Diagnostic odds ratios (DOR), likelihood ratios, and post-test probabilities were derived. Meta-regression evaluated the impact of FFR timing (CRD420261332222).
Results:
Five studies met inclusion criteria. Four studies (422 lesions) contributed to the primary analysis and 3 studies (250 lesions) to the secondary analysis. In the primary analysis, pooled sensitivity was 0.79 (95% CI, 0.68-0.87) and specificity 0.88 (95% CI, 0.80-0.93) (DOR 28). In the secondary analysis, sensitivity was 0.71 (95% CI, 0.57-0.82) and specificity 0.95 (95% CI, 0.90-0.98) (DOR 46.5), with comparable global discrimination (Youden index 0.66 vs 0.67). Meta-regression showed no significant interaction by reference timing (P = .39).
Conclusions:
Angiography-derived coronary physiology demonstrates good diagnostic performance in patients undergoing TAVI evaluation, with comparable overall discrimination when referenced to both pre- and post-TAVI FFR, although interpretation is limited by the absence of a stable reference standard across hemodynamic states.
Related Concept Videos
01:22Aortic Regurgitation II: Clinical Features and Diagnostic Tests
01:30Acute Coronary Syndrome III: Diagnostic Studies