Jung-Min Ahn1,2, Frederik M Zimmermann2,3, Satish Arora4,5,6, Ole-Geir Solberg4, Oskar Angerås7,8, Katrine Rolid4,5,6,9, Muzammil Rafique4,9, Lars Aaberge4, Kristjan Karason7,8, Kozo Okada10, Helen Luikart2, Kiran K Khush2, Yasuhiro Honda2, Nico H J Pijls3, Sang Eun Lee1, Jae-Joong Kim1, Seung-Jung Park1, Lars Gullestad4,5,6,9, William F Fearon2,11. 1. Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. 2. Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford Cardiovascular Institute, 300 Pasteur Drive, Room H2103, Stanford, CA 94305-5218, USA. 3. Catharina Hospital, Eindhoven, the Netherlands. 4. Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway. 5. KG Jebsen Center for Cardiac Research, University of Oslo, Oslo, Norway. 6. Center for Heart Failure Research, Oslo University Hospital, Oslo, Norway. 7. Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden. 8. Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg University, Gothenburg, Sweden. 9. Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway. 10. Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan. 11. Division of Cardiovascular Medicine, VA Palo Alto Health Care System, CA, USA.
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. Published on behalf of the European Society of Cardiology. All rights reserved.
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. Published on behalf of the European Society of Cardiology. All rights reserved.
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