PET‐CT Defined Micro‐Vascular Dysfunction and Cardiac Allograft Vasculopathy Risk Factors in Heart Transplant Recipients

• Published in: Clinical transplantation 2024-10, Vol.38 (10), p.e15445-n/a
• Main Authors: Milwidsky, Assi, Chan, Marvyn A., Travin, Mark, Gjelaj, Christiana, Saeed, Omar, Vukelic, Sasa, Rochlani, Yogita, Madan, Shivank, Shin, Julia J., Sims, Daniel B., Murthy, Sandhya, Chavez, Patricia, Jorde, Ulrich P., Patel, Snehal R.
• Format: Article
• Language: English
• Subjects: Adult; Allografts; coronary artery disease; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - etiology; diagnostic techniques and imaging: positron emission tomography; Female; Follow-Up Studies; Graft Rejection - diagnostic imaging; Graft Rejection - etiology; heart (allograft) function/dysfunction; Heart Transplantation - adverse effects; Humans; Male; Microcirculation; Middle Aged; Positron Emission Tomography Computed Tomography; Postoperative Complications; Prognosis; Retrospective Studies; Risk Factors; Transplant Recipients; Vascular Diseases - diagnostic imaging; Vascular Diseases - etiology
• ISSN: 0902-0063; 1399-0012; 1399-0012
• DOI: 10.1111/ctr.15445

ABSTRACT Microvascular dysfunction (MVD) is considered a form of cardiac allograft vasculopathy (CAV), independently associated with poor prognosis after heart transplantation (HTX). It is unknown whether traditional risk factors for CAV are also applicable to MVD. We retrospectively analyzed factors associated with MVD in 94 HTX recipients who completed a PET scan after a normal baseline left heart catheterization excluding epicardial CAV. MVD was defined by abnormal PET blood flow. The mean age was 52 ± 14 and MVD was found in 49 patients (53%). No donor risk factors were significantly associated with recipient MVD. Recipients risk factors for MVD included—diabetes mellitus (51% vs. 27%, p = 0.016) and hypertension (78% vs. 49%, p = 0.004) in patients with and without MVD, respectively. In a multivariate model, recipient hypertension and diabetes were the only significant determinants of MVD development (OR = 2.63, 95% CI [1.69–36.98], p = 0.009 and OR 2.1, 95% CI [1.10–15.38], p = 0.035, respectively). In conclusion, MVD was more associated with metabolic risk determinants rather than traditional CAV risk factors.