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Temporal changes in CT-derived fractional flow reserve in patients after heart transplantation
Simran P Sharma1,2, Javier Sanz3, Alexander Hirsch1,2
1Department of Cardiology, Thorax Centre, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.
Insights
Functional CT-derived fractional flow reserve (FFRct) monitoring in heart transplant (HTx) patients shows a decrease in coronary artery FFRct values and an increase in stenoses over two years. This temporal change may aid in detecting cardiac allograft vasculopathy (CAV) progression.
Area of Science:
- Cardiology
- Radiology
- Transplantation Medicine
Background:
- Cardiac allograft vasculopathy (CAV) is a significant concern in heart transplant (HTx) recipients.
- Assessing CAV progression and its underlying pathophysiology is crucial for long-term graft survival.
- CT-derived fractional flow reserve (FFRct) offers functional insights beyond anatomical assessment by coronary CT angiography (CCTA).
Purpose of the Study:
- To evaluate changes in FFRct and CAV progression over a 2-year period in HTx patients.
- To determine if temporal FFRct changes correlate with CAV development or worsening.
- To explore the potential of FFRct as a monitoring tool in post-HTx care.
Main Methods:
- Retrospective analysis of HTx patients with serial CCTAs performed 2 years apart.
- Precise anatomical matching of coronary locations between baseline and follow-up scans.
- FFRct values were measured at distal points of the LAD, LCX, and RCA, and the number of stenoses (>30%) was quantified.
Main Results:
- A cohort of 106 HTx patients (median age 57, 67% male) was analyzed.
- Significant decreases in distal FFRct were observed in the LAD, LCX, and RCA over 2 years (p < 0.001 to 0.009).
- The median number of coronary stenoses (>30%) increased from 1 to 2 (p = 0.009).
Conclusions:
- Distal coronary FFRct values decline, and the number of coronary stenoses increases in HTx patients over a 2-year follow-up.
- Temporal changes in FFRct may serve as an additional parameter for monitoring CAV progression.
- Further research is necessary to fully elucidate the role of temporal FFRct changes in HTx patient management.
Background:
Adding functional information by CT-derived fractional flow reserve (FFRct) to coronary CT angiography (CCTA) and assessing its temporal change may provide insight into the natural history and physiopathology of cardiac allograft vasculopathy (CAV) in heart transplantation (HTx) patients. We assessed FFRct changes as well as CAV progression over a 2-year period in HTx patients undergoing serial CT imaging.
Methods:
HTx patients from Erasmus MC and Mount Sinai Hospital, who had consecutive CCTAs 2 years apart were evaluated. FFRct analysis was performed for both scans. FFRct values at the most distal point in the left anterior descending (LAD), left circumflex (LCX), and right coronary artery (RCA) were measured after precisely matching the anatomical locations in both analyses. Also, the number of anatomical coronary stenoses of > 30% was scored.
Results:
In total, 106 patients (median age 57 [interquartile range 47-67] years, 67% male) at 9 [6-13] years after HTx at the time of the baseline CCTA were included. Median distal FFRct values significantly decreased from baseline to follow-up for the LAD from 0.85 [0.79-0.90] to 0.84 [0.76-0.90] (p = 0.001), LCX from 0.92 [0.88-0.96] to 0.91 [0.85-0.95] (p = 0.009), and RCA from 0.92 [0.86-0.95] to 0.90 [0.86-0.94] (p = 0.004). The number of focal anatomical stenoses of > 30% increased from a median of 1 [0-2] at baseline to 2 [0-3] at follow-up (p = 0.009).
Conclusions:
The distal coronary FFRct values in post-HTX patients in each of the three major coronary arteries decreased, and the number of focal coronary stenoses increased over a 2-year period. Temporal FFRct change rate may become an additional parameter in the follow-up of HTx patients, but more research is needed to elucidate its role.
Clinical Relevance Statement:
CT-derived fractional flow reserve (FFRct) is important post-heart transplant because of additional information on coronary CT angiography for cardiac allograft vasculopathy (CAV) detection. The decrease and degree of reduction in distal FFRct value may indicate progression in anatomic CAV burden.
Key Points:
CT-derived fractional flow reserve (FFRct) is important for monitoring cardiac allograft vasculopathy (CAV) in heart transplant patients. Over time, transplant patients showed a decrease in distal FFRct and an increase in coronary stenoses. Temporal changes in FFRct could be crucial for transplant follow-up, aiding in CAV detection.
