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Published on: August 2, 2024
Invasive Assessment of Coronary Physiology Predicts Late Mortality After Heart Transplantation
Hyoung-Mo Yang1, Kiran Khush1, Helen Luikart1
1From Stanford University, Stanford, CA (H.-M.Y., K.K., H.L., K.O., H.-S.L., Y.K., Y.H., A.C.Y., H.V., W.F.F.); and Ajou University School of Medicine, Suwon, South Korea (H.-M.Y., H.-S.L.).
Insights
Early invasive coronary physiology assessment after heart transplant predicts long-term survival. Fractional flow reserve and index of microcirculatory resistance are key prognostic indicators for death or retransplantation.
Area of Science:
- Cardiology
- Transplant Medicine
- Cardiovascular Physiology
Background:
- Heart transplantation is a life-saving procedure.
- Assessing coronary physiology post-transplant is crucial for long-term outcomes.
- Prognostic value of early invasive coronary assessment needs further clarification.
Purpose of the Study:
- To determine the prognostic significance of invasive coronary physiology measurements.
- To evaluate early post-transplant fractional flow reserve (FFR) and index of microcirculatory resistance (IMR).
- To correlate these measures with long-term survival free of death or retransplantation.
Main Methods:
- Seventy-four heart transplant recipients underwent FFR, coronary flow reserve, IMR, and intravascular ultrasound.
- Measurements were taken at baseline (soon after transplant) and 1 year post-transplant.
- Primary endpoint: cumulative survival free of death or retransplantation over a mean follow-up of 4.5 years.
Main Results:
- Lower event-free survival observed with baseline FFR <0.90 (42% vs 79%, P=0.01).
- Higher event rates in patients with IMR ≥20 at 1 year (39% vs 69%, P=0.03).
- Decreased or stable IMR from baseline to 1 year correlated with better survival (66% vs 36%, P=0.03).
Conclusions:
- Invasive coronary physiology, specifically FFR and IMR, are significant predictors of late death or retransplantation post-heart transplant.
- Baseline FFR <0.90 and 1-year IMR ≥20 independently predicted adverse outcomes.
- Intravascular ultrasound parameters did not show similar prognostic value.
Background:
The aim of this study is to determine the prognostic value of invasively assessing coronary physiology early after heart transplantation.
Methods And Results:
Seventy-four cardiac transplant recipients had fractional flow reserve, coronary flow reserve, index of microcirculatory resistance (IMR), and intravascular ultrasound performed down the left anterior descending coronary artery soon after (baseline) and 1 year after heart transplantation. The primary end point was the cumulative survival free of death or retransplantation at a mean follow-up of 4.5±3.5 years. The cumulative event-free survival was significantly lower in patients with a fractional flow reserve <0.90 at baseline (42% versus 79%; P=0.01) or an IMR ≥20 measured 1 year after heart transplantation (39% versus 69%; P=0.03). Patients in whom IMR decreased or did not change from baseline to 1 year had higher event-free survival compared with patients with an increase in IMR (66% versus 36%; P=0.03). Fractional flow reserve <0.90 at baseline (hazard ratio, 0.13; 95% confidence interval, 0.02-0.81; P=0.03), IMR ≥20 at 1 year (hazard ratio, 3.93; 95% confidence interval, 1.08-14.27; P=0.04), and rejection during the first year (hazard ratio, 6.00; 95% confidence interval, 1.56-23.09; P=0.009) were independent predictors of death/retransplantation, whereas intravascular ultrasound parameters were not.
Conclusions:
Invasive measures of coronary physiology (fractional flow reserve and IMR) determined early after heart transplantation are significant predictors of late death or retransplantation.
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