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Quantitative flow ratio computed from invasive coronary angiography as a predictor for cardiac allograft vasculopathy
Harsh Shah1, Injoon Lee2, Sriram Rao3
1Department of Cardiology, Jefferson Einstein Hospital, Philadelphia, PA, USA.
Insights
Quantitative flow ratio (QFR) shows promise in predicting cardiac allograft vasculopathy (CAV) after heart transplantation. This functional assessment may improve early detection and management of CAV, enhancing long-term survival for transplant recipients.
Area of Science:
- Cardiology
- Transplant Medicine
- Medical Imaging
Background:
- Cardiac allograft vasculopathy (CAV) significantly impacts long-term survival in heart transplant recipients.
- Current screening relies on invasive coronary angiography (ICA), which may have limitations in functional assessment.
- Quantitative flow ratio (QFR) offers a computational approach to assess coronary stenosis functionally.
Purpose of the Study:
- To evaluate the diagnostic and predictive value of QFR in assessing CAV in heart transplant recipients.
- To compare the efficacy of QFR with traditional angiography and intravascular ultrasound (IVUS) in predicting CAV development.
- To explore QFR's potential as a novel tool for monitoring CAV progression.
Main Methods:
- Consecutive heart transplant recipients undergoing serial coronary angiograms between 2013-2016 were enrolled.
- QFR was calculated offline from invasive coronary angiograms (ICA).
- CAV severity was assessed semi-quantitatively from ICA and IVUS, and correlated with QFR values over time.
Main Results:
- QFR was interpretable in 86% of initial angiograms and correlated well with subsequent CAV scores.
- An optimal QFR threshold of 0.88 demonstrated high sensitivity (0.94) for detecting non-obstructive CAV.
- QFR proved more accurate than ICA and IVUS in predicting future CAV severity.
Conclusions:
- QFR derived from ICA is a valuable tool for predicting the subsequent development of CAV.
- This functional flow assessment method may enhance the diagnosis and management of CAV in heart transplant patients.
- QFR holds potential for improving long-term outcomes in heart transplant recipients by enabling earlier and more accurate CAV detection.
Abstract:
Cardiac allograft vasculopathy (CAV) is a significant determinant of long-term survival in heart transplant recipients. Standard CAV screening typically utilizes invasive coronary angiography (ICA). Quantitative flow ratio (QFR) is a computational method for functional testing of coronary stenosis, and may add diagnostic value to ICA in assessing CAV. Consecutive subjects who received heart transplantation and underwent two separate routine coronary angiograms between January 2013 and April 2016 were enrolled. Coronary angiograms and IVUS were performed per local protocol at 1, 2, 3 and 5 years post-transplant. QFR was calculated offline. CAV was assessed semi-quantitively based on coronary angiogram results. Twenty-two patients were enrolled. Mean time from transplant to first included ICA was 2.1 years. QFR in at least 1 coronary vessel was interpretable in 19/22 (86%) of initial ICA (QFR1). QFR1 correlated well with the CAV score derived from the second ICA (CAV2) with a clustering of CAV at lower QFR values. In a receiver-operating characteristic (ROC) analysis, an optimal QFR threshold of 0.88 yielded 0.94 sensitivity and 0.67 specificity (AUC of 0.79) for at least non-obstructive subsequent CAV. Initial angiographically and intravascular ultrasound derived CAV severity poorly predicted subsequent CAV severity. QFR derived from invasive coronary angiography predicts subsequent development of CAV more accurately than angiography and intravascular ultrasound. This novel method of coronary flow assessment in recipients of heart transplantation may be useful to diagnose and predict subsequent CAV development.
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