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Updated: Jun 23, 2026
Evaluation of Coronary Flow Reserve After Myocardial Ischemia Reperfusion in Rats
Published on: June 28, 2019
Determinants of coronary flow reserve in heart transplantation: a study performed with contrast-enhanced
Elena Osto1, Francesco Tona, Annalisa Angelini
1Department of Cardiology, University of Padova, Padova, Italy.
Insights
Coronary flow reserve (CFR) reduction in heart transplant recipients is linked to cardiac allograft vasculopathy (CAV) and rejection. Reduced CFR may signal early CAV, potentially predicting long-term complications.
Area of Science:
- Cardiology
- Transplantation Immunology
- Cardiovascular Imaging
Background:
- Coronary flow reserve (CFR) is increasingly utilized in managing cardiac allograft vasculopathy (CAV).
- Identifying determinants of CFR is crucial for optimizing outcomes in heart transplantation (HT).
Purpose of the Study:
- To determine the factors influencing CFR in heart transplant recipients.
- To investigate the relationship between CFR, CAV, and rejection in HT patients.
Main Methods:
- CFR assessed via transthoracic echocardiography in 119 HT recipients.
- Hyperemic CFR calculated using adenosine infusion; rejection scores (RS) from endomyocardial biopsy.
- Angiographic CAV evaluated; CAV severity/diffusion index (SDI) computed.
Main Results:
- Multivariate analysis revealed CFR is associated with CAV, interventricular septum thickness, pre-HT ischemic heart disease, and SDI.
- In patients without CAV, CFR correlated with severe rejection scores (RS).
Conclusions:
- Left ventricular hypertrophy, CAV, and its severity independently reduce CFR.
- Reduced CFR may serve as an early indicator of CAV and associated risks.
- Microvascular dysfunction could play a role in late-term morbidity and mortality post-HT.
Background:
Determination of coronary flow reserve (CFR) is increasingly being used in cardiac allograft vasculopathy (CAV). We aimed to identify determinants of CFR in heart transplantation (HT).
Methods:
CFR was measured by transthoracic echocardiography in 119 HT recipients (97 men, 22 women; 50 +/- 12 years of age at HT and 8 +/- 5 years post-HT). CFR was expressed as the ratio of hyperemic (adenosine infusion at a rate of 0.14 mg/kg) to basal diastolic flow velocity. Rejection scores (RS) on endomyocardial biopsy were calculated. Angiographic CAV was analyzed using a qualitative grading system. The coronary tree was divided into 17 traits and a CAV severity/diffusion index (SDI) was calculated for each patient, summing the scores assigned to all lesions.
Results:
Upon multivariate analysis, CFR was related to CAV (p = 0.001), interventricular septum thickness (p = 0.01), ischemic heart disease pre-HT (p = 0.02) and SDI and SDI/segment number (p < 0.0001 and p = 0.003, respectively). In patients without CAV, CFR was related only to RS for severe grades (p = 0.01).
Conclusions:
Left ventricular hypertrophy, CAV and its severity/diffusion independently contribute to reduced CFR. In patients without angiographic CAV, CFR was only independently related to RS. Because a high rejection burden is associated with increased risk of CAV, CFR reduction may be an early marker of CAV. Microvascular dysfunction may contribute to the late morbidity and mortality seen in HT.
