Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.
Department of Cardiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.
Eur Radiol. 2022 Mar;32(3):1843-1852. doi: 10.1007/s00330-021-08246-5. Epub 2021 Sep 15.
Invasively measured fractional flow reserve (FFR) is associated with outcome in heart transplant (HTx) patients. Coronary computed tomography angiography (CCTA)-derived FFR (FFRct) provides additional functional information from anatomical CT images. We describe the first use of FFRct in HTx patients.
HTx patients underwent CCTA with FFRct to screen for cardiac allograft vasculopathy. FFRct was measured distal to each coronary stenosis > 30% and FFRct ≤ 0.8 indicated hemodynamically significant stenosis. FFRct was also measured at the most distal location of each vessel. Overall distal FFRct was calculated as the mean of the distal values in the left, right, and circumflex coronary artery in each patient.
Seventy-three patients (age 56 (42-65) years, 63% males) at 11 (8-16) years after HTx were included. Eighteen (25%) patients had a focal hemodynamically significant stenosis (stenosis > 30% with FFRct ≤ 0.8). In the 55 patients without a hemodynamically significant focal FFRct stenosis (FFRct > 0.80), the distal left anterior descending artery FFRct was < 0.90 in 74% of the patients and 10 (18%) patients had ≥ 1 coronary artery with a distal FFRct ≤ 0.8, including 1 with a distal FFRct ≤ 0.8 in all coronaries. Overall distal FFRct in patients without focal stenosis was 0.88 (0.86-0.91), 0.87 (0.86-0.90), and 0.88 (0.86-0.91) (median with 25th-75th percentile) at 5-9, 10-14, or ≥ 15 years post-transplantation, respectively (p = 0.93).
FFRct performed on CCTA scans of HTx patients demonstrated that 25% of patients had a focal coronary stenosis with FFRct ≤ 0.8. Even without a focal stenosis, FFRct values are often abnormal in HTx patients.
• This is the first report describing the use of FFRct in in heart transplant patients. • FFRct identifies patients after heart transplantation with hemodynamically significant coronary stenosis. • Even without a focal stenosis, FFRct values are often abnormal in heart transplant patients.
有创测量的血流储备分数（FFR）与心脏移植（HTx）患者的预后相关。冠状动脉计算机断层血管造影（CCTA）衍生的 FFR（FFRct）可从解剖 CT 图像中提供额外的功能信息。我们描述了 FFRct 在 HTx 患者中的首次应用。
HTx 患者行 CCTA 联合 FFRct 筛查心脏移植后冠状动脉病变。FFRct 在每个狭窄>30%的冠状动脉远端进行测量，FFRct≤0.8 提示存在血流动力学显著狭窄。FFRct 还在每个血管的最远端部位进行测量。每位患者的左、右和回旋冠状动脉的远端 FFRct 的平均值计算为总体远端 FFRct。
共纳入 73 例 HTx 后 11（8-16）年的患者（年龄 56（42-65）岁，63%为男性）。18 例（25%）患者存在局灶性血流动力学显著狭窄（狭窄>30%且 FFRct≤0.8）。在 55 例无血流动力学显著局灶性 FFRct 狭窄（FFRct>0.80）的患者中，左前降支远端 FFRct<0.90 的患者占 74%，10 例（18%）患者存在≥1 支远端 FFRct≤0.8 的冠状动脉，其中 1 例所有冠状动脉的远端 FFRct≤0.8。无局灶性狭窄的患者的总体远端 FFRct 分别为 0.88（0.86-0.91）、0.87（0.86-0.90）和 0.88（0.86-0.91）（中位数，25%-75%），分别在移植后 5-9、10-14 或≥15 年（p=0.93）。
在 HTx 患者的 CCTA 扫描中进行 FFRct 显示，25%的患者存在 FFRct≤0.8 的局灶性冠状动脉狭窄。即使没有局灶性狭窄，FFRct 值在 HTx 患者中也往往异常。
这是第一篇描述 FFRct 在心脏移植患者中的应用的报道。
FFRct 可识别心脏移植后存在血流动力学显著冠状动脉狭窄的患者。
即使没有局灶性狭窄，FFRct 值在心脏移植患者中也往往异常。
Zotero 插件