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Multicenter Study
. 2021 Dec 21;42(48):4918-4929.
doi: 10.1093/eurheartj/ehab568.

Prognostic value of comprehensive intracoronary physiology assessment early after heart transplantation

Jung-Min Ahn  1   2 , Frederik M Zimmermann  2   3 , Satish Arora  4   5   6 , Ole-Geir Solberg  4 , Oskar Angerås  7   8 , Katrine Rolid  4   5   6   9 , Muzammil Rafique  4   9 , Lars Aaberge  4 , Kristjan Karason  7   8 , Kozo Okada  10 , Helen Luikart  2 , Kiran K Khush  2 , Yasuhiro Honda  2 , Nico H J Pijls  3 , Sang Eun Lee  1 , Jae-Joong Kim  1 , Seung-Jung Park  1 , Lars Gullestad  4   5   6   9 , William F Fearon  2   11
Affiliations
Multicenter Study

Prognostic value of comprehensive intracoronary physiology assessment early after heart transplantation

Jung-Min Ahn et al. Eur Heart J. .

Abstract

Aims: We evaluated the long-term prognostic value of invasively assessing coronary physiology after heart transplantation in a large multicentre registry.

Methods and results: Comprehensive intracoronary physiology assessment measuring fractional flow reserve (FFR), the index of microcirculatory resistance (IMR), and coronary flow reserve (CFR) was performed in 254 patients at baseline (a median of 7.2 weeks) and in 240 patients at 1 year after transplantation (199 patients had both baseline and 1-year measurement). Patients were classified into those with normal physiology, reduced FFR (FFR ≤ 0.80), and microvascular dysfunction (either IMR ≥ 25 or CFR ≤ 2.0 with FFR > 0.80). The primary outcome was the composite of death or re-transplantation at 10 years. At baseline, 5.5% had reduced FFR; 36.6% had microvascular dysfunction. Baseline reduced FFR [adjusted hazard ratio (aHR) 2.33, 95% confidence interval (CI) 0.88-6.15; P = 0.088] and microvascular dysfunction (aHR 0.88, 95% CI 0.44-1.79; P = 0.73) were not predictors of death and re-transplantation at 10 years. At 1 year, 5.0% had reduced FFR; 23.8% had microvascular dysfunction. One-year reduced FFR (aHR 2.98, 95% CI 1.13-7.87; P = 0.028) and microvascular dysfunction (aHR 2.33, 95% CI 1.19-4.59; P = 0.015) were associated with significantly increased risk of death or re-transplantation at 10 years. Invasive measures of coronary physiology improved the prognostic performance of clinical variables (χ2 improvement: 7.41, P = 0.006). However, intravascular ultrasound-derived changes in maximal intimal thickness were not predictive of outcomes.

Conclusion: Abnormal coronary physiology 1 year after heart transplantation was common and was a significant predictor of death or re-transplantation at 10 years.

Keywords: Cardiac allograft vasculopathy; Coronary stenosis; Heart transplantation; Microvascular dysfunction; Prognosis.

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Figures

None
Abnormal coronary physiology at 1 year after heart transplantation. CRF, coronary flow reserve; FFR, fractional flow reserve; IMR, index of microcirculatory resistance.
Figure 1
Figure 1
Distribution of coronary physiological abnormality at baseline (A) and 1 year (B). CRF, coronary flow reserve; FFR, fractional flow reserve; IMR, index of microcirculatory resistance.
Figure 2
Figure 2
Physiological abnormality at baseline (A) and 1 year (B) and the risk of death and re-transplantation at 10 years. Event rates were derived from Kaplan–Meier estimates and were compared by log-rank test. FFR, fractional flow reserve.
Figure 3
Figure 3
Changes in physiological abnormality of Reduced FFR (A) and Microvascular dysfunction (B) between baseline and 1 year and the risk of death and re-transplantation at 10 years. Event rates were derived from Kaplan–Meier estimates and were compared by log-rank test. FFR, fractional flow reserve.
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