Mileva Niya, Nagumo Sakura, Gallinoro Emanuele, Sonck Jeroen, Verstreken Sofie, Dierkcx Riet, Heggermont Ward, Bartunek Jozef, Goethals Marc, Heyse Alex, Barbato Emanuele, De Bruyne Bernard, Collet Carlos, Vanderheyden Marc
Cardiovascular Center Aalst, OLV Clinic, 9300 Aalst, Belgium.
Cardiology Clinic, Alexandrovska University Hospital, 1430 Sofia, Bulgaria.
Diagnostics (Basel). 2021 Sep 24;11(10):1750. doi: 10.3390/diagnostics11101750.
Cardiac transplant-related vasculopathy remains a leading cause of morbidity and mortality in heart transplant (HTx) recipients. Recently, coronary angiography-derived vessel fractional flow reserve (vFFR) has emerged as a new diagnostic computational tool to functionally evaluate the severity of coronary artery disease. Although vFFR estimates have been shown to perform well against invasive FFR in atherosclerotic coronary artery disease, data on the use of vFFR in heart transplant recipients suffering from cardiac transplant-related arteriopathy are lacking. The aim of the presented study was to validate coronary angiography-derived vessel fractional flow reserve to calculate fractional flow reserve in HTx patients with and without cardiac transplant-related vasculopathy. A prospective, single center study of HTx patients referred for annual check-up, undergoing surveillance coronarography was conducted. Invasive FFR was measured using a motorized device at the speed of 1.0 mm/s in all three major coronary arteries. Angiography-derived pullback FFR was derived from the angiogram and compared with invasive FFR pullback curve. Overall, 18,059 FFR values were extracted from the FFR pullback curves from 23 HTx patients. The mean age was 59.3 ± 9.7 years, the mean time after transplantation was 5.24 years [IQR 1.20, 11.25]. A total of 39 vessels from 23 patients (24 LAD, 11 LCX, 4 RCA) were analyzed. Mean distal vFFR was 0.87 ± 0.14 whereas invasive distal FFR was 0.88 ± 0.17. An excellent correlation was found between invasive distal FFR and vFFR (r = 0.92; < 0.001). The correlation of the pullback tracing was high, with a correlation coefficient between vFFR and invasive FFR pullback values of 0.72 (95% CI 0.71 to 0.73, < 0.001). The mean difference between vFFR and invasive FFR pullback values was -0.01 with 0.06 of SD (limits of agreements -0.12 to 0.13). In HTx patients, coronary angiography-derived FFR correlates excellently with invasively measured wire-derived FFR. Therefore, angiography derived FFR could be used as a novel diagnostic tool to quantify the functional severity of graft vasculopathy.
心脏移植相关血管病变仍然是心脏移植（HTx）受者发病和死亡的主要原因。最近，基于冠状动脉造影的血管血流储备分数（vFFR）已成为一种新的诊断计算工具，用于从功能上评估冠状动脉疾病的严重程度。尽管在动脉粥样硬化性冠状动脉疾病中，vFFR估计值已被证明与有创血流储备分数（FFR）表现相当，但在患有心脏移植相关动脉病变的心脏移植受者中使用vFFR的数据仍然缺乏。本研究的目的是验证基于冠状动脉造影的血管血流储备分数，以计算有无心脏移植相关血管病变的HTx患者的血流储备分数。对因年度体检而接受监测冠状动脉造影的HTx患者进行了一项前瞻性单中心研究。在所有三支主要冠状动脉中，使用电动装置以1.0 mm/s的速度测量有创FFR。从血管造影中得出回撤FFR，并与有创FFR回撤曲线进行比较。总体而言，从23例HTx患者的FFR回撤曲线中提取了18059个FFR值。平均年龄为59.3±9.7岁，移植后平均时间为5.24年[四分位间距1.20，11.25]。对23例患者的39支血管（24支左前降支、11支左旋支、4支右冠状动脉）进行了分析。平均远端vFFR为0.87±0.14，而有创远端FFR为0.88±0.17。发现有创远端FFR与vFFR之间存在极好的相关性（r = 0.92；<0.001）。回撤描记的相关性很高，vFFR与有创FFR回撤值之间的相关系数为0.72（95%CI 0.71至0.73，<0.001）。vFFR与有创FFR回撤值之间的平均差异为-0.01，标准差为0.06（一致性界限为-0.12至0.13）。在HTx患者中，基于冠状动脉造影的FFR与有创测量的导丝FFR具有极好的相关性。因此，血管造影得出的FFR可作为一种新型诊断工具，用于量化移植血管病变的功能严重程度。
