Fractional flow reserve substitutes in aortic stenosis

“Accept no substitutes!”. Does this slogan belong solely to the domain of the advertiser, or might it apply to medicine beyond generic drug substitutions at the pharmacy? The QASTA study, published in this issue of EuroIntervention1, demands that we address the question in regard to coronary physiology for patients with aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI).

In that study, 138 lesions from 7 centres in 5 countries underwent fractional flow reserve (FFR) assessment as part of the TAVI workup, then post hoc analysis of the angiograms to compute the quantitative flow ratio (QFR). Does QFR provide ...