Role of Quantitative Flow Ratio in Predicting Future Cardiac Allograft Vasculopathy in Heart Transplant Recipients
Related Experiment Video
Updated: Sep 23, 2025
Author Spotlight: Enhancing Graft Viability Assessment Through Quantitative Metrics and Innovative Reservoir Systems
Published on: August 2, 2024
Giosafat Spitaleri1,2, Salvatore Brugaletta2, Luciano Potena3
1Heart Failure Clinic and Cardiology Service, University Hospital Germans Trias i Pujol, Badalona, Spain (G.S.).
Insights
Quantitative flow ratio (QFR) can predict cardiac allograft vasculopathy (CAV) in heart transplant recipients. A QFR of ≤0.95 at baseline coronary angiography indicates a higher risk of developing CAV and adverse clinical outcomes.
Area of Science:
- Cardiology
- Transplantation Medicine
- Medical Imaging
Background:
- Coronary angiography is the standard for diagnosing cardiac allograft vasculopathy (CAV), but it often detects the disease late.
- Quantitative flow ratio (QFR) offers a noninvasive method to assess flow-limiting lesions.
Purpose of the Study:
- To evaluate the role of QFR in predicting the development of CAV in heart transplant recipients.
- To assess the association between baseline QFR and long-term clinical outcomes.
Main Methods:
- Retrospective analysis of 143 heart transplant recipients with no baseline CAV.
- QFR computation performed on 241 vessels from baseline coronary angiography.
- Assessment of the relationship between vessel QFR and the incidence of angiographic CAV (≥50% stenosis) over a median follow-up of 6.0 years.
Main Results:
- A QFR cutoff of ≤0.95 was identified as predictive of CAV (AUC, 0.81; P<0.001).
- QFR ≤0.95 significantly increased the risk of vessel-related CAV (aHR, 20.87; P<0.001).
- QFR ≤0.95 in ≥2 vessels was linked to a higher incidence of cardiovascular death or graft dysfunction (71.4% vs. 5.1%; P<0.001).
Conclusions:
- Baseline QFR is a safe and reliable tool for predicting vessel-related CAV in heart transplant recipients.
- QFR can help identify patients at risk for adverse clinical outcomes, including cardiovascular death and graft dysfunction.
Background:
Coronary angiography is the gold standard for cardiac allograft vasculopathy (CAV) diagnosis, but it usually detects the disease at an advanced stage. We investigated the role of quantitative flow ratio (QFR), a noninvasive tool to identify potentially flow-limiting lesions, in predicting CAV development in heart transplant recipients.
Methods:
Consecutive heart transplant recipients with no evidence of angiographic CAV at baseline coronary angiography were retrospectively included between January 2010 and December 2015, and QFR computation was performed. The relationship between vessel QFR and the occurrence of angiographic vessel-related CAV (≥50% stenosis) was assessed.
Results:
One hundred forty-three patients were included and QFR computation was feasible in 241 vessels. The median value of QFR at baseline coronary angiography was 0.98 (interquartile range, 0.94-1.00). During a median follow-up of 6.0 years (interquartile range, 4.6-7.8 years), vessel-related CAV occurred in 25 (10.4%) vessels. Receiver-operating characteristic curve analysis identified a QFR best cutoff of ≤0.95 (area under the curve, 0.81 [95% CI, 0.71-0.90]; P<0.001). QFR≤0.95 was associated with an increased risk of vessel-related CAV (adjusted hazard ratio, 20.87 [95% CI, 5.35-81.43]; P<0.001). In an exploratory analysis, QFR≤0.95 in at least 2 vessels was associated with higher incidence of cardiovascular death or late graft dysfunction (71.4% in recipients with 2-3 vessels affected versus 5.1% in recipients with 0-1 vessels affected, P<0.001).
Conclusions:
In a cohort of heart transplant recipients, QFR computation at baseline coronary angiography may be a safe and reliable tool to predict vessel-related CAV and clinical outcomes at long-term follow-up.
