Can Grading of Mild Cardiac Allograft Vasculopathy be Further Refined? An angiographic and physiologic assessment of heart transplant recipients with ISHLT CAV 1

作者：N. Prasad, Erin Harris, M. Yuzefpolskaya, E. DeFilippis, Paolo C. Colombo, G. Sayer, M. Chernovolenko, Justin A Fried, David Bae, K. T. Oh, J. Raikhelkar, V. Topkara, M.R. Castillo, Elaine Y. Lam, Farhana Latif, Koji Takeda, N. Uriel, Andrew J. Einstein, Kevin J Clerkin · 发表于：The Journal of Heart and Lung Transplantation · 年份：2024 · DOI：10.1016/j.healun.2024.12.013 · 被引用次数：5 · 研究领域：Medicine

Background: Cardiac allograft vasculopathy (CAV) results in impaired blood flow in both epicardial vessels and the microvasculature and is a leading cause of poor outcomes in heart transplant (HT) recipients. Most patients have mild (ISHLT CAV 1) disease. This study examined outcomes amongst those with ISHLT CAV 1 and investigated the value of physiologic assessment via cardiac positron emission tomography/computed tomography (PET/CT) for added risk stratification. Methods: CAV was graded using ISHLT criteria. Those with CAV 1 were further sub-grouped into CAV 1a (maximal lesion < 30% stenosis) or CAV 1b (maximal lesion ≥ 30% stenosis). Results: 299 heart transplant recipients underwent invasive coronary angiography for CAV assessment with median follow up 4.7 years. ISHLT CAV 1 was associated with a 2.9-fold risk of death/re-transplantation compared to ISHLT CAV 0 (95% CI 1.7 −5.3, p<0.001). Of those with ISHLT CAV 1, 12% had ISHLT CAV 1b which was associated with a 2.8 times greater risk of death/re-transplantation compared to CAV 1a (95% CI 1.4–5.9, p=0.003). In a subgroup of 158 patients with contemporary cardiac PET/CT, amongst those with CAV 1a a myocardial blood flow reserve (MBFR) ≤ 2 was associated with a 4.6-fold risk of death/re-transplantation compared to a normal MBFR (95% CI 1.7–12.6, p=0.001). Conclusion: Patients with ISHLT CAV 1 fared worse than those with ISHLT CAV 0. Within ISHLT CAV 1, patients with CAV 1b had worse outcomes than those with CAV 1a. Amongst...