Prognostic value of comprehensive intracoronary physiology assessment early after heart transplantation

• Published in: European heart journal 2021-12, Vol.42 (48), p.4918-4929
• Main Authors: Ahn, Jung-Min, Zimmermann, Frederik M, Arora, Satish, Solberg, Ole-Geir, Angerås, Oskar, Rolid, Katrine, Rafique, Muzammil, Aaberge, Lars, Karason, Kristjan, Okada, Kozo, Luikart, Helen, Khush, Kiran K, Honda, Yasuhiro, Pijls, Nico H J, Lee, Sang Eun, Kim, Jae-Joong, Park, Seung-Jung, Gullestad, Lars, Fearon, William F
• Format: Article
• Language: English
• Subjects: Cardiac allograft vasculopathy; Cardiac and Cardiovascular Systems; Cardiac Catheterization; Coronary Angiography; Coronary Stenosis; Coronary Vessels - diagnostic imaging; Coronary Vessels - surgery; Fast Track Clinical Research; Fractional Flow Reserve, Myocardial; Heart Transplantation; Humans; Kardiologi; Microcirculation; Microvascular dysfunction; Predictive Value of Tests; Prognosis
• ISSN: 0195-668X; 1522-9645; 1522-9645
• DOI: 10.1093/eurheartj/ehab568

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. Graphical Abstract Abnormal coronary physiology at 1 year after heart transplantation. CRF, coronary flow reserve; FFR, fractional flow reserve; IMR, index of microcirculatory resistance.