Noninvasive Physiologic Assessment of Cardiac Allograft Vasculopathy Is Prognostic for Post-Transplant Events.
Noninvasive Physiologic Assessment of Cardiac Allograft Vasculopathy Is Prognostic for Post-Transplant Events.
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DOI：
10.1016/j.jacc.2022.08.751
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发表时间：
2022-10-25
影响因子：
24
通讯作者：
Einstein, Andrew J.
中科院分区：
文献类型：
--
作者：
Clerkin, Kevin J.;Topkara, Veli K.;Farr, Maryjane A.;Jain, Rashmi;Colombo, Paolo C.;Restaino, Susan;Sayer, Gabriel;Castillo, Michelle;Lam, Elaine Y.;Chernovolenko, Margarita;Yuzefpolskaya, Melana;DeFilippis, Ersilia;Latif, Farhana;Zorn, Emmanuel;Takeda, Koji;Johnson, Lynne L.;Uriel, Nir;Einstein, Andrew J.
关键词：
心脏病冠状动脉和微脉管系统的心脏病冠状动脉疾病（CAV）导致血液流动受损，这是移植后死亡率的主要原因。
该分析检查了HT受体的结果，并通过13n- ammonia potitron发射断层扫描心肌灌注成像（PET）检测到了心肌流动储备（MBFR）和微血管CAV的结果。
根据MBFR的总MBFR：> 2.0和≤2.0，将接受PET评估CAV的HT接受者被纳入了两组。
71（39％）患者的MBFR≤2.0。腹部住院（HR 10.1，95％CI 3.43–29.9， p <0.0001）。
心肌血流储备异常，即使没有心外膜CAV，也确定了高死亡或后植入术的高风险。
同种异体移植血管病（CAV）在心外膜冠状动脉和微举动脉中导致血液流动受损，并且是移植后发病率和无侵蚀性评估的主要原因。抗原，CV死亡增加了12倍，十倍孤立的微血管CAV患者的CV升高是死亡或重新植入的近四倍。
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. 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). 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. 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. Abnormal myocardial blood flow reserve, even in the absence of epicardial CAV, identifies patients at a high risk of death or retransplantation. Measures of myocardial blood flow provide prognostic information in addition to traditional CAV assessment. Cardiac allograft vasculopathy (CAV) causes impaired blood flow in both epicardial coronary arteries and the microvasculature and is a leading cause of post-transplant morbidity and mortality. Non-invasive assessment of CAV with PET myocardial perfusion imaging provides measurements of myocardial blood flow. HT recipients with a reduced (≤2.0) myocardial blood flow reserve had a 7-fold increase in death or retransplantation, 12-fold increase in CV death, and 10-fold increase in CV hospitalization. Patients with isolated microvascular CAV had a nearly four times the risk of death or retransplantation. Measures of myocardial blood flow provide prognostic information in addition to traditional CAV assessment.
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影响因子：
39.3
作者：
Ahn, Jung-Min;Zimmermann, Frederik M.;Fearon, William F.
通讯作者：
Fearon, William F.
影响因子：
8.9
作者：
Chirakarnjanakorn, Srisakul;Starling, Randall C.;Desai, Milind Y.
通讯作者：
Desai, Milind Y.
影响因子：
8.9
作者：
Mehra, Mandeep R.;Crespo-Leiro, Maria G.;Uber, Patricia A.
通讯作者：
Uber, Patricia A.
影响因子：
13
作者：
Agarwal, Shikhar;Parashar, Akhil;Oliveira, Guilherme H.
通讯作者：
Oliveira, Guilherme H.
影响因子：
24
作者：
Einstein, Andrew J.;Johnson, Lynne L.;Bokhari, Sabahat;Son, Jessica;Thompson, Randall C.;Bateman, Timothy M.;Hayes, Sean W.;Berman, Daniel S.
通讯作者：
Berman, Daniel S.