Abstract
ObjectivesInvasively measured fractional flow reserve (FFR) is associated with outcome in heart transplant (HTx) patients. Coronary computed tomography angiography (CCTA)–derived FFR (FFRct) provides additional functional information from anatomical CT images. We describe the first use of FFRct in HTx patients.MethodsHTx patients underwent CCTA with FFRct to screen for cardiac allograft vasculopathy. FFRct was measured distal to each coronary stenosis > 30% and FFRct ≤ 0.8 indicated hemodynamically significant stenosis. FFRct was also measured at the most distal location of each vessel. Overall distal FFRct was calculated as the mean of the distal values in the left, right, and circumflex coronary artery in each patient.ResultsSeventy-three patients (age 56 (42–65) years, 63% males) at 11 (8–16) years after HTx were included. Eighteen (25%) patients had a focal hemodynamically significant stenosis (stenosis > 30% with FFRct ≤ 0.8). In the 55 patients without a hemodynamically significant focal FFRct stenosis (FFRct > 0.80), the distal left anterior descending artery FFRct was < 0.90 in 74% of the patients and 10 (18%) patients had ≥ 1 coronary artery with a distal FFRct ≤ 0.8, including 1 with a distal FFRct ≤ 0.8 in all coronaries. Overall distal FFRct in patients without focal stenosis was 0.88 (0.86–0.91), 0.87 (0.86–0.90), and 0.88 (0.86–0.91) (median with 25th–75th percentile) at 5–9, 10–14, or ≥ 15 years post-transplantation, respectively (p = 0.93).ConclusionsFFRct performed on CCTA scans of HTx patients demonstrated that 25% of patients had a focal coronary stenosis with FFRct ≤ 0.8. Even without a focal stenosis, FFRct values are often abnormal in HTx patients.Key Points• This is the first report describing the use of FFRct in in heart transplant patients.• FFRct identifies patients after heart transplantation with hemodynamically significant coronary stenosis.• Even without a focal stenosis, FFRct values are often abnormal in heart transplant patients.
Highlights
Cardiac allograft vasculopathy (CAV) is an accelerated fibroproliferative disease that affects the coronary arteries in heart transplant (HTx) patients leading to coronary stenoses [1, 2]
The aim of this study is to describe the initial results of Coronary computed tomography angiography (CCTA) with FFR values based on CCTA images (FFRct) analysis in a cohort of HTx patients
We describe the first cohort of HTx patients that underwent FFRct analysis of CCTA performed for routine annual screening for CAV
Summary
Cardiac allograft vasculopathy (CAV) is an accelerated fibroproliferative disease that affects the coronary arteries in heart transplant (HTx) patients leading to coronary stenoses [1, 2]. Data from the International Society for Heart and Lung Transplantation (ISHLT) show that almost 50% of patients have CAV at 10 years post-transplant [3, 4]. CAV progresses and usually revascularization, and in select cases, even retransplantation is needed [1]. Patients with CAV seldom present with classical symptoms of angina because the transplanted heart is denervated [1]. The ISHLT currently recommends annual or biannual invasive coronary angiography (ICA) to evaluate for the development of CAV [5]. Beyond anatomical evaluation invasive fractional flow reserve (FFR) measurements have been shown to provide complementary information and has been shown to be an independent predictor of death and retransplantation [6]
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