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Author Spotlight: Enhancing Graft Viability Assessment Through Quantitative Metrics and Innovative Reservoir Systems
Published on: August 2, 2024
Vessel Fractional Flow Reserve and Graft Vasculopathy in Heart Transplant Recipients
Sakura Nagumo1,2, Emanuele Gallinoro1,3, Alessandro Candreva1
1Cardiovascular Center Aalst, OLV Clinic, 9300 Aalst, Belgium.
Insights
Vessel fractional flow reserve (vFFR) can detect cardiac allograft vasculopathy (CAV) missed by standard angiography in heart transplant recipients. This functional assessment may improve risk stratification for long-term survival after heart transplantation.
Area of Science:
- Cardiology
- Transplantation Medicine
- Medical Imaging
Background:
- Cardiac allograft vasculopathy (CAV) significantly impacts long-term survival post-heart transplantation (HTx).
- Conventional coronary angiography (COR) has limitations in assessing the severity and extent of CAV.
- Vessel fractional flow reserve (vFFR) derived from COR offers a computational method to quantify functional coronary artery disease severity.
Purpose of the Study:
- To evaluate the utility of vFFR in detecting CAV in heart transplant recipients.
- To compare vFFR findings with established anatomical criteria for CAV.
Main Methods:
- Sixty-five HTx patients undergoing surveillance COR were assessed.
- CAV extent was graded using International Society of Heart and Lung Transplantation (ISHLT) criteria.
- Three-dimensional coronary geometries from COR were used to compute vFFR, assessing pressure loss.
Main Results:
- Analysis of 173 vessels revealed a mean vFFR of 0.84 ± 0.15.
- A vFFR ≤ 0.80 was identified in 24 patients (48 vessels), indicating functional impairment.
- vFFR reclassified 31.9% of patients compared to ISHLT criteria, detecting CAV in 8 patients (34.8%) with a CAV score of 0.
Conclusions:
- vFFR detects epicardial conductance impairment not visible with conventional angiography in some HTx patients.
- This suggests diffuse vasculopathy may be present even without anatomical evidence of CAV.
- vFFR shows potential as a valuable tool for risk stratification in heart transplant recipients.
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, vessel fractional 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.
