Non-invasive Physiologic Assessment of Cardiac Allograft Vasculopathy is Prognostic for Post-Transplant Events

作者：K. Clerkin, V. Topkara, M. Farr, R. Jain, P. Colombo, S. Restaino, G. Sayer, M. Castillo, Elaine Y. Lam, M. Chernovolenko, M. Yuzefpolskaya, E. DeFilippis, F. Latif, E. Zorn, K. Takeda, L. Johnson, N. Uriel, A. Einstein · 发表于：Journal of the American College of Cardiology · 年份：2022 · DOI：10.1016/j.jacc.2022.08.751 · 被引用次数：39 · 研究领域：Medicine

Background: Cardiac allograft vasculopathy (CAV) causes impaired blood flow in both epicardial coronary arteries and the microvasculature. A leading cause of post-transplant mortality, CAV impacts 50% of heart transplant (HT) recipients within 10 years of HT. Objectives: This analysis examined the outcomes of HT recipients with reduced myocardial blood flow reserve (MBFR) and microvascular CAV detected by 13N-ammonia positron emission tomography myocardial perfusion imaging (PET). Methods: 181 HT recipients who underwent PET to assess for CAV were included with a median follow-up of 4.7 years. Patients were classified into two groups according to the total MBFR: >2.0 and ≤2.0. Microvascular CAV was defined as no epicardial CAV detected by PET and/or coronary angiography, but with an MBFR ≤2.0 by PET. Results: 71 (39%) patients had an MBFR ≤2.0. Patients with an MBFR ≤2.0 experienced an increased risk for all outcomes: 7-fold increase in death or retransplantation (HR 7.05, 95% CI 3.2–15.6, p<0.0001), 12-fold increase in cardiovascular death (HR 12.0, 95% CI 2.64–54.12, p=0.001), and 10-fold increase in cardiovascular hospitalization (HR 10.1, 95% CI 3.43–29.9, p<0.0001). Five-year mean survival was 302 days less than those with an MBFR >2.0 (95% CI 260.2–345.4 days, p<0.0001). Microvascular CAV (adjusted HR 3.86, 95% CI 1.58–9.40, p=0.003) was independently associated with an increased risk of death or retransplantation. Conclusions: Abnormal myocardial blood flow reserve, ev...