Heart Failure Clinic and Cardiology Service, University Hospital Germans Trias i Pujol, Badalona, Spain (G.S.).
Hospital Clínic, Cardiovascular Clinic Institute, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Spain (G.S., S.B., M.F.).
Circ Cardiovasc Interv. 2022 May;15(5):e011656. doi: 10.1161/CIRCINTERVENTIONS.121.011656. Epub 2022 May 17.
Coronary angiography is the gold standard for cardiac allograft vasculopathy (CAV) diagnosis, but it usually detects the disease at an advanced stage. We investigated the role of quantitative flow ratio (QFR), a noninvasive tool to identify potentially flow-limiting lesions, in predicting CAV development in heart transplant recipients.
Consecutive heart transplant recipients with no evidence of angiographic CAV at baseline coronary angiography were retrospectively included between January 2010 and December 2015, and QFR computation was performed. The relationship between vessel QFR and the occurrence of angiographic vessel-related CAV (50% stenosis) was assessed.
One hundred forty-three patients were included and QFR computation was feasible in 241 vessels. The median value of QFR at baseline coronary angiography was 0.98 (interquartile range, 0.94-1.00). During a median follow-up of 6.0 years (interquartile range, 4.6-7.8 years), vessel-related CAV occurred in 25 (10.4%) vessels. Receiver-operating characteristic curve analysis identified a QFR best cutoff of 0.95 (area under the curve, 0.81 [95% CI, 0.71-0.90]; <0.001). QFR0.95 was associated with an increased risk of vessel-related CAV (adjusted hazard ratio, 20.87 [95% CI, 5.35-81.43]; <0.001). In an exploratory analysis, QFR0.95 in at least 2 vessels was associated with higher incidence of cardiovascular death or late graft dysfunction (71.4% in recipients with 2-3 vessels affected versus 5.1% in recipients with 0-1 vessels affected, <0.001).
In a cohort of heart transplant recipients, QFR computation at baseline coronary angiography may be a safe and reliable tool to predict vessel-related CAV and clinical outcomes at long-term follow-up.
冠状动脉造影是诊断心脏移植物血管病（CAV）的金标准，但它通常在疾病晚期才发现。我们研究了一种非侵入性工具——定量血流比值（QFR）在识别潜在的血流受限病变中的作用，以预测心脏移植受者 CAV 的发展。
回顾性纳入 2010 年 1 月至 2015 年 12 月期间基线冠状动脉造影无血管造影 CAV 证据的连续心脏移植受者，并进行 QFR 计算。评估血管 QFR 与血管相关 CAV（50%狭窄）发生的关系。
共纳入 143 例患者，241 个血管可进行 QFR 计算。基线冠状动脉造影 QFR 的中位数为 0.98（四分位距，0.94-1.00）。中位随访 6.0 年（四分位距，4.6-7.8 年）期间，25 个（10.4%）血管发生血管相关 CAV。受试者工作特征曲线分析确定 QFR 最佳截断值为 0.95（曲线下面积，0.81 [95%CI，0.71-0.90]；<0.001）。QFR0.95 与血管相关 CAV 的风险增加相关（调整后的危险比，20.87 [95%CI，5.35-81.43]；<0.001）。在一项探索性分析中，至少 2 个血管的 QFR0.95 与心血管死亡或晚期移植物功能障碍的发生率较高相关（受影响的血管为 2-3 个的患者为 71.4%，受影响的血管为 0-1 个的患者为 5.1%，<0.001）。
在一组心脏移植受者中，基线冠状动脉造影时的 QFR 计算可能是一种安全可靠的工具，可预测血管相关 CAV 和长期随访的临床结局。
