Coronary Flow Velocity Reserve and Myocardial Deformation Predict Long-Term Outcomes in Heart Transplant Recipients
Related Experiment Video
Updated: Oct 26, 2025
Evaluation of Coronary Flow Reserve After Myocardial Ischemia Reperfusion in Rats
Published on: June 28, 2019
Kamilla P Bjerre1, Tor S Clemmensen1, Steen H Poulsen2
1Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
Insights
Noninvasive cardiac allograft vasculopathy (CAV) surveillance using coronary flow velocity reserve (CFVR) and left ventricular global longitudinal strain (LVGLS) can predict mortality and major adverse cardiac events after heart transplantation (HTx). These noninvasive measures offer valuable prognostic information.
Area of Science:
- Cardiology
- Transplantation Medicine
- Diagnostic Imaging
Background:
- Cardiac allograft vasculopathy (CAV) surveillance after heart transplantation (HTx) traditionally relies on invasive coronary angiography.
- Developing noninvasive methods for CAV surveillance is crucial for patient management and outcomes.
- Left ventricular global longitudinal strain (LVGLS) and coronary flow velocity reserve (CFVR) are potential noninvasive markers.
Purpose of the Study:
- To evaluate the relationship between LVGLS, noninvasive CFVR, and the presence and severity of CAV post-HTx.
- To assess the prognostic value of LVGLS and CFVR for major adverse cardiac events (MACE) and mortality in HTx recipients.
- To determine the combined utility of LVGLS and CFVR in predicting CAV and patient outcomes.
Main Methods:
- Doppler echocardiography was used to assess CFVR and LVGLS in 98 HTx patients.
- Patients were monitored for all-cause mortality and MACE, including hospitalization for heart failure, cardiovascular death, and CAV progression.
- Statistical analyses were performed to correlate LVGLS and CFVR with CAV severity and clinical outcomes.
Main Results:
- Low CFVR (<2.0) and worsened LVGLS (≥-15.5%) were significantly associated with reduced MACE-free survival and increased all-cause mortality.
- Combined low CFVR and worsened LVGLS demonstrated incremental prognostic value, independent of CAV severity and time since HTx.
- The combination of high CFVR and improved LVGLS showed a high negative predictive value (94.5%) for ruling out significant CAV.
Conclusions:
- Low CFVR and worsened LVGLS are prevalent in HTx patients with severe CAV and are strong independent predictors of adverse outcomes.
- The combined assessment of CFVR and LVGLS provides significant prognostic information and can effectively help rule out significant CAV.
- These noninvasive parameters may be considered for routine surveillance of CAV in heart transplant recipients.
Background:
After heart transplantation (HTx), invasive coronary angiography is the gold standard for surveillance of cardiac allograft vasculopathy (CAV). Noninvasive CAV surveillance is desirable. The authors examined left ventricular global longitudinal strain (LVGLS) and noninvasive coronary flow velocity reserve (CFVR) related to CAV and prognosis after HTx.
Methods:
Doppler echocardiographic CFVR and LVGLS were evaluated in 98 HTx patients. All-cause mortality and major adverse cardiac events (MACE), including hospitalization for heart failure, cardiovascular death, and significant CAV progression, were recorded.
Results:
Median follow-up duration was 3.3 years (range: 1.7-5.4 years). Patients with low CFVR (<2.0; n = 20) showed reduced MACE-free survival (hazard ratio, 4.3; 95% CI, 2.2-8.4; P < .0001) and increased all-cause mortality (hazard ratio: 4.7; 95% CI: 2.0-11.3; P < .0001) compared with patients with high CFVR (≥2.0; n = 78). Worsened LVGLS (≥-15.5%) was also a strong independent predictor of MACE and cardiovascular and all-cause mortality. Combined low CFVR and worsened LVGLS provided incremental prognostic value, even after adjustment for CAV and time since HTx. The prevalence of low CFVR increased significantly with CAV severity, and the prevalence of combined low CFVR and/or worsened LVGLS was high in patients with moderate CAV (86%) and those with severe CAV (83%). The negative predictive value of combined high CFVR and improved LVGLS to rule out significant CAV was 94.5% (95% CI, 86.2%-98.4%), whereas the positive predictive value was 39.0% (95% CI, 25.3%-54.3%). The model had sensitivity of 84.2% (95% CI, 63.6%-95.3%) and specificity of 67.5% (95% CI, 56.6%-77.2%) for one or more abnormal parameters.
Conclusions:
In HTx patients with severe CAV, a higher prevalence of low CFVR and worsened LVGLS was observed. Both measurements were strong independent predictors of MACE and all-cause mortality in HTx patients. Combined CFVR and LVGLS provided incremental prognostic value and showed an excellent ability to rule out significant CAV and may be considered as part of routine CAV surveillance of HTx patients.
More Related Videos
08:49Author Spotlight: Enhancing Graft Viability Assessment Through Quantitative Metrics and Innovative Reservoir Systems
Published on: August 2, 2024
05:07Author Spotlight: Improved Localization and Monitoring of Coronary Flow Reserve Using Modified PLAX View in Mice
Published on: August 25, 2023