Cardiovascular Center Aalst, OLV Clinic, 9300 Aalst, Belgium.
Division of Cardiology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, 2278501 Kanagawa, Japan.
J Interv Cardiol. 2020 Jul 12;2020:9835151. doi: 10.1155/2020/9835151. eCollection 2020.
Cardiac allograft vasculopathy (CAV) remains the Achilles' heel of long-term survival after heart transplantation (HTx). The severity and extent of CAV is graded with conventional coronary angiography (COR) which has several limitations. Recently, vessel fractional flow reserve (vFFR) derived from COR has emerged as a diagnostic computational tool to quantify the functional severity of coronary artery disease.
The present study assessed the usefulness of vFFR to detect CAV in HTx recipients.
In HTx patients referred for annual check-up, undergoing surveillance COR, the extent of CAV was graded according to the criteria proposed by the international society of heart and lung transplantation (ISHLT). In addition, three-dimensional coronary geometries were constructed from COR to calculate pressure losses using vFFR.
In 65 HTx patients with a mean age of 53.7 ± 10.1 years, 8.5 years (IQR 1.90, 15.2) years after HTx, a total number of 173 vessels (59 LAD, 61 LCX, and 53 RCA) were analyzed. The mean vFFR was 0.84 ± 0.15 and median was 0.88 (IQR 0.79, 0.94). A vFFR ≤ 0.80 was present in 24 patients (48 vessels). HTx patients with a history of ischemic cardiomyopathy (ICMP) had numerically lower vFFR as compared to those with non-ICMP (0.70 ± 0.22 vs. 0.79 ± 0.13, = 0.06). The use of vFFR reclassified 31.9% of patients compared to the anatomical ISHLT criteria. Despite a CAV score of 0, a pathological vFFR ≤ 0.80 was detected in 8 patients (34.8%).
The impairment in epicardial conductance assessed by vFFR in a subgroup of patients without CAV according to standard ISHLT criteria suggests the presence of a diffuse vasculopathy undetectable by conventional angiography. Therefore, we speculate that vFFR may be useful in risk stratification after HTx.
心脏同种异体移植血管病（CAV）仍然是心脏移植（HTx）后长期存活的阿喀琉斯之踵。CAV 的严重程度和范围通过常规冠状动脉造影（COR）进行分级，但该方法存在一些局限性。最近，来源于 COR 的血管血流储备分数（vFFR）作为一种诊断计算工具，已经出现并被用于量化冠状动脉疾病的功能严重程度。
本研究旨在评估 vFFR 检测 HTx 受者 CAV 的效用。
在接受年度检查并进行 COR 监测的 HTx 患者中，根据国际心肺移植协会（ISHLT）提出的标准对 CAV 的程度进行分级。此外，从 COR 构建三维冠状动脉几何结构，以使用 vFFR 计算压力损失。
在 65 名 HTx 患者中，中位年龄为 53.7±10.1 岁，HTx 后中位时间为 8.5 年（IQR 1.90，15.2），共分析了 173 支血管（59 支 LAD、61 支 LCX 和 53 支 RCA）。平均 vFFR 为 0.84±0.15，中位数为 0.88（IQR 0.79，0.94）。24 名患者（48 支血管）的 vFFR≤0.80。与非缺血性心肌病（ICMP）患者相比，有缺血性心肌病（ICMP）病史的 HTx 患者的 vFFR 数值较低（0.70±0.22 比 0.79±0.13， = 0.06）。与解剖学 ISHLT 标准相比，vFFR 重新分类了 31.9%的患者。尽管 CAV 评分为 0，但在 8 名患者（34.8%）中仍检测到病理性 vFFR≤0.80。
根据标准 ISHLT 标准，在无 CAV 的患者亚组中，vFFR 评估的心外膜传导受损表明存在常规血管造影无法检测到的弥漫性血管病。因此，我们推测 vFFR 可能对 HTx 后风险分层有用。
