Invasive Coronary Physiology in Heart Transplant Recipients: State-of-the-Art Review

Area of Science:

• Cardiology
• Transplantation Medicine
• Vascular Biology

Background:

• Cardiac allograft vasculopathy (CAV) is a primary driver of graft failure and mortality in heart transplant recipients.
• Current standard-of-care diagnostics include coronary angiography and intravascular ultrasound in the early post-transplant phase.
• These methods provide anatomical information but may not fully capture functional aspects of CAV.

Purpose of the Study:

• To evaluate the role of invasive coronary physiological assessment in predicting long-term outcomes in heart transplant recipients.
• To determine if physiological assessment offers prognostic value beyond standard imaging modalities for CAV.
• To identify patients at increased risk for accelerated CAV and acute rejection.

Main Methods:

• Review of studies investigating invasive coronary physiological assessment in heart transplant recipients.
• Comparison of prognostic data from physiological assessment versus standard angiography and intravascular ultrasound.
• Analysis of correlation between physiological parameters and rates of CAV, graft failure, and acute rejection.

Main Results:

• Invasive coronary physiological assessment provides complementary prognostic data in heart transplant recipients.
• Physiological assessment aids in identifying patients at risk for accelerated cardiac allograft vasculopathy.
• This modality helps stratify patients susceptible to acute rejection.

Conclusions:

• Invasive coronary physiological assessment is a valuable tool for long-term risk stratification in heart transplant recipients.
• It complements standard imaging by providing functional insights into CAV development.
• Incorporating physiological assessment may improve patient management and outcomes by identifying high-risk individuals early.