Prognostic value of comprehensive intracoronary physiology assessment early after heart transplantation
Prognostic value of comprehensive intracoronary physiology assessment early after heart transplantation
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DOI：
10.1093/eurheartj/ehab568
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发表时间：
2021-10-19
影响因子：
39.3
通讯作者：
Fearon, William F.
中科院分区：
文献类型：
--
作者：
Ahn, Jung-Min;Zimmermann, Frederik M.;Fearon, William F.
目的：我们在一个大型的多中心注册中心评估了心脏移植后冠状动脉生理学的长期预后价值。方法和结果：综合冠状动脉内生理学评估测量血流储备分数（FFR），微循环阻力指数（IMR），在基线时对254例患者进行了冠状动脉血流储备（CFR）检查（中位数为7.2周）和240例移植后1年的患者（199例患者有基线和1年的测量）。患者被分类为生理功能正常、FFR降低（FFR = 25或CFR 0.80）的患者。主要结局是10年时死亡或再次移植的复合终点。基线时，5.5%的患者FFR降低; 36.6%的患者微血管功能障碍。基线FFR降低[校正的风险比（aHR）2.33，95%置信区间（CI）0.88-6.15; P=0.088]和微血管功能障碍（aHR 0.88，95% CI 0.44-1.79; P=0.73）不是10年时死亡和再次移植的预测因子。1年时，5.0%的患者FFR降低; 23.8%的患者微血管功能障碍。1年FFR降低（aHR 2.98，95% CI 1.13-7.87; P=0.028）和微血管功能障碍（aHR 2.33，95% CI 1.19-4.59; P=0.015）与10年时死亡或再次移植风险显著增加相关。冠状动脉生理学的侵入性测量改善了临床变量的预后表现（卡方积分改善：7.41，P=0.006）。然而，血管内超声衍生的最大内膜厚度的变化是不预测outcomes.Conclusion冠状动脉生理异常心脏移植后1年是常见的，是一个显着的预测死亡或再次移植在10年。
Aims We evaluated the long-term prognostic value of invasively assessing coronary physiology after heart transplantation in a large multicentre registry.Methods and results Comprehensive intracoronary physiology assessment measuring fractional flow reserve (FFR), the index of microcirculatory resistance (IMR), and coronary flow reserve (CFR) was performed in 254 patients at baseline (a median of 7.2weeks) and in 240 patients at 1year after transplantation (199 patients had both baseline and 1-year measurement). Patients were classified into those with normal physiology, reduced FFR (FFR = 25 or CFR 0.80). The primary outcome was the composite of death or re-transplantation at 10years. At baseline, 5.5% had reduced FFR; 36.6% had microvascular dysfunction. Baseline reduced FFR [adjusted hazard ratio (aHR) 2.33, 95% confidence interval (CI) 0.88-6.15; P=0.088] and microvascular dysfunction (aHR 0.88, 95% CI 0.44-1.79; P=0.73) were not predictors of death and re-transplantation at 10 years. At 1year, 5.0% had reduced FFR; 23.8% had microvascular dysfunction. One-year reduced FFR (aHR 2.98, 95% CI 1.13-7.87; P=0.028) and microvascular dysfunction (aHR 2.33, 95% CI 1.19-4.59; P=0.015) were associated with significantly increased risk of death or re-transplantation at 10years. Invasive measures of coronary physiology improved the prognostic performance of clinical variables (chi(2) improvement: 7.41, P=0.006). However, intravascular ultrasound-derived changes in maximal intimal thickness were not predictive of outcomes.Conclusion Abnormal coronary physiology 1 year after heart transplantation was common and was a significant predictor of death or re-transplantation at 10 years.