TY - JOUR
T1 - Vessel Fractional Flow Reserve and Graft Vasculopathy in Heart Transplant Recipients
AU - Nagumo, S.
AU - Gallinoro, E.
AU - Candreva, A.
AU - Mizukami, T.
AU - Monizzi, G.
AU - Kodeboina, M.
AU - Verstreken, S.
AU - Dierckx, R.
AU - Heggermont, W.
AU - Bartunek, J.
AU - Goethals, M.
AU - Buytaert, D.
AU - De Bruyne, B.
AU - Sonck, J.
AU - Collet, C.
AU - Vanderheyden, M.
N1 - Publisher Copyright:
© 2020 Sakura Nagumo et al.
PY - 2020/7/14
Y1 - 2020/7/14
N2 - Background. Cardiac allograft vasculopathy (CAV) remains the Achilles' heel of long-term survival after heart transplantation (HTx). The severity and extent of CAV is graded with conventional coronary angiography (COR) which has several limitations. Recently, vesselfractional flow reserve (vFFR) derived from COR has emerged as a diagnostic computational tool to quantify the functional severity of coronary artery disease.Purpose. The present study assessed the usefulness of vFFR to detect CAV in HTx recipients.Methods. In HTx patients referred for annual check-up, undergoing surveillance COR, the extent of CAV was graded according to the criteria proposed by the international society of heart and lung transplantation (ISHLT). In addition, three-dimensional coronary geometries were constructed from COR to calculate pressure losses using vFFR.Results. In 65 HTx patients with a mean age of 53.7 +/- 10.1 years, 8.5 years (IQR 1.90, 15.2) years after HTx, a total number of 173 vessels (59 LAD, 61 LCX, and 53 RCA) were analyzed. The mean vFFR was 0.84 +/- 0.15 and median was 0.88 (IQR 0.79, 0.94). A vFFR <= 0.80 was present in 24 patients (48 vessels). HTx patients with a history of ischemic cardiomyopathy (ICMP) had numerically lower vFFR as compared to those with non-ICMP (0.70 +/- 0.22 vs. 0.79 +/- 0.13,p=0.06). The use of vFFR reclassified 31.9% of patients compared to the anatomical ISHLT criteria. Despite a CAV score of 0, a pathological vFFR <= 0.80 was detected in 8 patients (34.8%).Conclusion. The impairment in epicardial conductance assessed by vFFR in a subgroup of patients without CAV according to standard ISHLT criteria suggests the presence of a diffuse vasculopathy undetectable by conventional angiography. Therefore, we speculate that vFFR may be useful in risk stratification after HTx.
AB - Background. Cardiac allograft vasculopathy (CAV) remains the Achilles' heel of long-term survival after heart transplantation (HTx). The severity and extent of CAV is graded with conventional coronary angiography (COR) which has several limitations. Recently, vesselfractional flow reserve (vFFR) derived from COR has emerged as a diagnostic computational tool to quantify the functional severity of coronary artery disease.Purpose. The present study assessed the usefulness of vFFR to detect CAV in HTx recipients.Methods. In HTx patients referred for annual check-up, undergoing surveillance COR, the extent of CAV was graded according to the criteria proposed by the international society of heart and lung transplantation (ISHLT). In addition, three-dimensional coronary geometries were constructed from COR to calculate pressure losses using vFFR.Results. In 65 HTx patients with a mean age of 53.7 +/- 10.1 years, 8.5 years (IQR 1.90, 15.2) years after HTx, a total number of 173 vessels (59 LAD, 61 LCX, and 53 RCA) were analyzed. The mean vFFR was 0.84 +/- 0.15 and median was 0.88 (IQR 0.79, 0.94). A vFFR <= 0.80 was present in 24 patients (48 vessels). HTx patients with a history of ischemic cardiomyopathy (ICMP) had numerically lower vFFR as compared to those with non-ICMP (0.70 +/- 0.22 vs. 0.79 +/- 0.13,p=0.06). The use of vFFR reclassified 31.9% of patients compared to the anatomical ISHLT criteria. Despite a CAV score of 0, a pathological vFFR <= 0.80 was detected in 8 patients (34.8%).Conclusion. The impairment in epicardial conductance assessed by vFFR in a subgroup of patients without CAV according to standard ISHLT criteria suggests the presence of a diffuse vasculopathy undetectable by conventional angiography. Therefore, we speculate that vFFR may be useful in risk stratification after HTx.
KW - cardiac allograft vasculopathy
KW - coronary physiology
KW - intracoronary ultrasound
KW - INTRACORONARY ULTRASOUND
KW - CARDIAC ALLOGRAFT VASCULOPATHY
KW - CORONARY PHYSIOLOGY
U2 - 10.1155/2020/9835151
DO - 10.1155/2020/9835151
M3 - Article
C2 - 32733172
SN - 0896-4327
VL - 2020
JO - Journal of Interventional Cardiology
JF - Journal of Interventional Cardiology
M1 - 9835151
ER -