Invasive assessment of coronary physiology predicts late mortality after heart transplantation

Hyoung Mo Yang, Kiran Khush, Helen Luikart, Kozo Okada, Hong Seok Lim, Yuhei Kobayashi, Yasuhiro Honda, Alan C. Yeung, Hannah Valantine, William F. Fearon

Research output: Contribution to journalArticlepeer-review

35 Scopus citations

Abstract

Background - The aim of this study is to determine the prognostic value of invasively assessing coronary physiology early after heart transplantation. Methods and Results - Seventy-four cardiac transplant recipients had fractional flow reserve, coronary flow reserve, index of microcirculatory resistance (IMR), and intravascular ultrasound performed down the left anterior descending coronary artery soon after (baseline) and 1 year after heart transplantation. The primary end point was the cumulative survival free of death or retransplantation at a mean follow-up of 4.5±3.5 years. The cumulative event-free survival was significantly lower in patients with a fractional flow reserve <0.90 at baseline (42% versus 79%; P=0.01) or an IMR ≥20 measured 1 year after heart transplantation (39% versus 69%; P=0.03). Patients in whom IMR decreased or did not change from baseline to 1 year had higher event-free survival compared with patients with an increase in IMR (66% versus 36%; P=0.03). Fractional flow reserve <0.90 at baseline (hazard ratio, 0.13; 95% confidence interval, 0.02-0.81; P=0.03), IMR ≥20 at 1 year (hazard ratio, 3.93; 95% confidence interval, 1.08-14.27; P=0.04), and rejection during the first year (hazard ratio, 6.00; 95% confidence interval, 1.56-23.09; P=0.009) were independent predictors of death/retransplantation, whereas intravascular ultrasound parameters were not. Conclusions - Invasive measures of coronary physiology (fractional flow reserve and IMR) determined early after heart transplantation are significant predictors of late death or retransplantation.

Original languageEnglish (US)
Pages (from-to)1945-1950
Number of pages6
JournalCirculation
Volume133
Issue number20
DOIs
StatePublished - May 17 2016
Externally publishedYes

Keywords

  • heart transplantation
  • physiology
  • treatment outcome

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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