{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T05:03:51Z","timestamp":1789707831730,"version":"4.0.1"},"reference-count":18,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T00:00:00Z","timestamp":1789603200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T00:00:00Z","timestamp":1789603200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cathet Cardio Intervent"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Coronary artery disease frequently coexists with severe aortic stenosis (AS) and contributes to adverse outcomes after transcatheter aortic valve implantation (TAVI). Conventional lesion\u2010based assessments may underestimate the cumulative impact of diffuse coronary physiologic impairment in this population. This study evaluated the prognostic significance of mean angiography\u2010derived fractional flow reserve (vFFR) as a patient\u2010level marker of coronary physiologic burden in patients undergoing TAVI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Between January 2017 and April 2022, 164 patients with severe AS who underwent coronary angiography prior to TAVI without significant epicardial stenosis (&lt;\u200970%) were retrospectively analyzed. vFFR values were computed for all three major coronary arteries, and mean vFFR was calculated for each patient. The primary endpoint was a composite of all\u2010cause death or heart failure hospitalization (HFH). Mean vFFR was analyzed as a continuous variable.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Patients had an overall mean vFFR of 0.89\u2009\u00b1\u20090.07 and were stratified into high (&gt;\u20090.85) or low (\u2264\u20090.85) vFFR cohorts. During a mean follow\u2010up of 1241\u2009\u00b1\u2009867 days, the primary endpoint occurred in 43 patients (26.2%). Lower mean vFFR, lower left ventricular ejection fraction, higher NT\u2010proBNP levels, lower estimated glomerular filtration rate, and higher STS score were associated with adverse outcomes. In contrast, the lowest single\u2010vessel vFFR was not associated with the primary endpoint. When analyzed as a continuous variable, each 0.1 decrease in mean vFFR was independently associated with a higher risk of the composite outcome (adjusted hazard ratio 1.62, 95% CI 1.03\u20132.55;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.035). Restricted cubic spline analysis demonstrated a non\u2010linear inverse relationship between mean vFFR and clinical risk.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Lower mean vFFR, reflecting greater coronary physiologic burden, was independently associated with adverse clinical outcomes after TAVI, even in the absence of angiographically significant stenosis. These findings suggest that patient\u2010level physiologic impairment may provide incremental prognostic information beyond lesion\u2010based assessment, supporting a more physiology\u2010informed approach to coronary evaluation in patients undergoing TAVI.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ccd.70889","type":"journal-article","created":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T04:16:58Z","timestamp":1789705018000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Coronary Physiologic Burden Assessed by Mean Angiography\u2010Derived Fractional Flow Reserve Predicts Outcomes After Transcatheter Aortic Valve Implantation"],"prefix":"10.1002","author":[{"given":"Enrico Paolo","family":"Legaspi","sequence":"first","affiliation":[{"name":"Cardiovascular center, Taipei Veterans General Hospital Taipei Taiwan"},{"name":"Chinese General Hospital and Medical Center Manila Philippines"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9636-1104","authenticated-orcid":false,"given":"Patrick W.","family":"Serruys","sequence":"additional","affiliation":[{"name":"Corrib Research Centre for Advanced Imaging and Core Laboratory University of Galway Galway Ireland"},{"name":"School of Medicine, University of Galway Galway Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0426-9360","authenticated-orcid":false,"given":"Tsung\u2010Ying","family":"Tsai","sequence":"additional","affiliation":[{"name":"Corrib Research Centre for Advanced Imaging and Core Laboratory University of Galway Galway Ireland"},{"name":"School of Medicine, University of Galway Galway Ireland"},{"name":"Cardiovascular center, Taichung Veterans General Hospital  Taichung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi\u2010Lin","family":"Tsai","sequence":"additional","affiliation":[{"name":"Cardiovascular center, Taipei Veterans General Hospital Taipei Taiwan"},{"name":"School of Medicine, National Yang Ming Chiao Tung University Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Su\u2010Chan","family":"Chen","sequence":"additional","affiliation":[{"name":"Cardiovascular center, Taipei Veterans General Hospital Taipei Taiwan"},{"name":"School of Medicine, National Yang Ming Chiao Tung University Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9871-6514","authenticated-orcid":false,"given":"Ching\u2010Wei","family":"Lee","sequence":"additional","affiliation":[{"name":"Cardiovascular center, Taipei Veterans General Hospital Taipei Taiwan"},{"name":"School of Medicine, National Yang Ming Chiao Tung University Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pruthvi C.","family":"Revaiah","sequence":"additional","affiliation":[{"name":"Corrib Research Centre for Advanced Imaging and Core Laboratory University of Galway Galway Ireland"},{"name":"School of Medicine, University of Galway Galway Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tai\u2010Wei","family":"Chen","sequence":"additional","affiliation":[{"name":"Cardiovascular center, Taipei Veterans General Hospital Taipei Taiwan"},{"name":"School of Medicine, National Yang Ming Chiao Tung University Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiao\u2010Po","family":"Hsu","sequence":"additional","affiliation":[{"name":"Cardiovascular center, Taipei Veterans General Hospital Taipei Taiwan"},{"name":"School of Medicine, National Yang Ming Chiao Tung University Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2799-1185","authenticated-orcid":false,"given":"Chun\u2010Chin","family":"Chang","sequence":"additional","affiliation":[{"name":"Cardiovascular center, Taipei Veterans General Hospital Taipei Taiwan"},{"name":"School of Medicine, National Yang Ming Chiao Tung University Taipei Taiwan"},{"name":"Institute of Clinical Medicine, National Yang Ming Chiao Tung University Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9441-1836","authenticated-orcid":false,"given":"Shih\u2010Hsien","family":"Sung","sequence":"additional","affiliation":[{"name":"Cardiovascular center, Taipei Veterans General Hospital Taipei Taiwan"},{"name":"School of Medicine, National Yang Ming Chiao Tung University Taipei Taiwan"},{"name":"Institute of Emergency and Critical Care Medicine, National Yang Ming Chiao Tung University Taipei Taiwan"},{"name":"Department of Medical Research Taipei Veterans General Hospital Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,17]]},"reference":[{"issue":"3","key":"e_1_2_10_2_1","doi-asserted-by":"crossref","first-page":"630","DOI":"10.1016\/S0735-1097(96)00563-3","article-title":"Clinical Factors Associated With Calcific Aortic Valve Disease","volume":"29","author":"Stewart B. 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C.","year":"2021","journal-title":"Frontiers in Cardiovascular Medicine"},{"issue":"2","key":"e_1_2_10_13_1","first-page":"201","article-title":"Coronary Physiological Indexes to Evaluate Myocardial Ischemia in Patients With Aortic Stenosis Undergoing Valve Replacement","volume":"18","author":"Minten L.","year":"2025","journal-title":"JACC: Cardiovascular Interventions"},{"key":"e_1_2_10_14_1","doi-asserted-by":"crossref","DOI":"10.1016\/j.ijcard.2024.132761","article-title":"Influence of Physiological Patterns of Coronary Disease on Fractional Flow Reserve and Instantaneous Wave\u2010Free Ratio Changes in Patients Undergoing TAVI","volume":"420","author":"Fezzi S.","year":"2025","journal-title":"International Journal of Cardiology"},{"issue":"18","key":"e_1_2_10_15_1","first-page":"1965","article-title":"ACTIVATION (PercutAneous Coronary Intervention Prior to Transcatheter Aortic VAlve ImplantaTION)","volume":"14","author":"Patterson T.","year":"2021","journal-title":"JACC: Cardiovascular Interventions"},{"issue":"7","key":"e_1_2_10_16_1","doi-asserted-by":"crossref","first-page":"589","DOI":"10.4244\/EIJ-D-23-00186","article-title":"Comparison of Different Percutaneous Revascularisation Timing Strategies in Patients Undergoing Transcatheter Aortic Valve Implantation","volume":"19","author":"Rheude T.","year":"2023","journal-title":"EuroIntervention"},{"issue":"23","key":"e_1_2_10_17_1","doi-asserted-by":"crossref","first-page":"2189","DOI":"10.1056\/NEJMoa2401513","article-title":"PCI in Patients Undergoing Transcatheter Aortic\u2010Valve Implantation","volume":"391","author":"L\u00f8nborg J.","year":"2024","journal-title":"New England Journal of Medicine"},{"issue":"25","key":"e_1_2_10_18_1","doi-asserted-by":"crossref","first-page":"3257","DOI":"10.1093\/eurheartj\/ehaf974","article-title":"Physiology Vs Angiography\u2010Guided Percutaneous Coronary Intervention in Transcatheter Aortic Valve Implantation: The FAITAVI Trial","volume":"47","author":"Ribichini F. 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