Integrated Assessment of Coronary Physiology Based on Coronary Angiography in Heart Transplant Patients.

IF 2.1 3区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Catheterization and Cardiovascular Interventions Pub Date : 2024-11-27 DOI:10.1002/ccd.31314

Simone Fezzi, Gabriele Pesarini, Ludovica Guerrieri, Allegra Urbani, Andrea Bottardi, Domenico Tavella, William Wijns, Shengxian Tu, Roberto Scarsini, Flavio Ribichini

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引用次数: 0

Abstract

Background: Early detection of cardiac allograft vasculopathy after heart transplant (HTx) with invasive coronary angiography is challenging.

Aims: The study aimed to determine if computational techniques able to assess epicardial lesions, by means of Murray's law-based quantitative flow ratio (μFR), and microvascular physiology, by means of angiography microvascular resistance (AMR), enhance risk stratification in HTx patients with nonsignificant coronary artery disease.

Methods: The cohort consisted of 86 consecutive HTx patients (200 epicardial vessels) with stenosis < 50% at baseline. μFR ≤ 0.80 indicated coronary ischemia, while AMR ≥ 2.5 suggested microvascular dysfunction. Clinical events were assessed over a median follow-up of 43 months, focusing on the relationship between μFR and target vessel failure (TVF), and between AMR and heart failure (HF) hospitalizations.

Results: At baseline, mean μFR was 0.94 ± 0.08, with eight vessels (4.0%) disclosing flow-limiting lesions, while AMR was 2.4 ± 0.7, with 80 vessels/40 patients (40.0%/46.5%) having microvascular dysfunction. TVF-related segments were associated with lower mean μFR values (0.89 ± 0.14 vs. 0.95 ± 0.05; p < 0.007) compared TVF-free segments. At the receiver operating characteristic curve a μFR ≤ 0.93 demonstrated an area under the curve of 0.632 (95% CI: 0.562-0.699) in predicting TVF occurrence, showing an accuracy of 76.0%, a sensitivity of 46.9%, a specificity of 81.6%, a negative predictive value of 89.0%, and a positive predictive value of 32.6%. μFR ≤ 0.93 showed a significant interaction with TVF occurrence at 43 months (32.6% vs. 11.0%; HR: 2.96; 95% CI: 1.26-6.96; p = 0.013). Microvascular dysfunction showed a significant interaction with HF hospitalizations occurence (AMR: 2.8 ± 4.4 vs. 2.4 ± 4.5; p = 0.001; CMD: 27.5% vs. 4.3%; HR: 7.36; 95% CI: 2.45-22.07; p = 0.002).

Conclusions: Angiography-derived epicardial and microvascular physiology computation may improve risk stratification of heart transplanted patients.

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根据冠状动脉造影综合评估心脏移植患者的冠状动脉生理状况。

背景：目的：该研究旨在确定计算技术是否能够通过基于默里定律的定量血流比（μFR）评估心外膜病变，以及通过血管造影微血管阻力（AMR）评估微血管生理学，从而加强对无明显冠状动脉疾病的心脏移植（HTx）患者的风险分层：结果：基线时，平均μFR值为0.1，而AMR值为0.1：基线时，平均μFR为0.94±0.08，其中8条血管（4.0%）存在血流受限病变，而AMR为2.4±0.7，其中80条血管/40名患者（40.0%/46.5%）存在微血管功能障碍。TVF相关区段的平均μFR值较低（0.89±0.14 vs. 0.95±0.05；P 结论：TVF相关区段的平均μFR值较低：血管造影衍生的心外膜和微血管生理计算可改善心脏移植患者的风险分层。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Catheterization and Cardiovascular Interventions 医学-心血管系统

CiteScore

5.40

自引率

8.70%

发文量

419

审稿时长

2 months

期刊介绍： Catheterization and Cardiovascular Interventions is an international journal covering the broad field of cardiovascular diseases. Subject material includes basic and clinical information that is derived from or related to invasive and interventional coronary or peripheral vascular techniques. The journal focuses on material that will be of immediate practical value to physicians providing patient care in the clinical laboratory setting. To accomplish this, the journal publishes Preliminary Reports and Work In Progress articles that complement the traditional Original Studies, Case Reports, and Comprehensive Reviews. Perspective and insight concerning controversial subjects and evolving technologies are provided regularly through Editorial Commentaries furnished by members of the Editorial Board and other experts. Articles are subject to double-blind peer review and complete editorial evaluation prior to any decision regarding acceptability.