Background

After heart transplantation (HTx), invasive coronary angiography is the gold standard for surveillance of cardiac allograft vasculopathy (CAV). Noninvasive CAV surveillance is desirable. The authors examined left ventricular global longitudinal strain (LVGLS) and noninvasive coronary flow velocity reserve (CFVR) related to CAV and prognosis after HTx.

Methods

Doppler echocardiographic CFVR and LVGLS were evaluated in 98 HTx patients. All-cause mortality and major adverse cardiac events (MACE), including hospitalization for heart failure, cardiovascular death, and significant CAV progression, were recorded.

Results

Median follow-up duration was 3.3 years (range: 1.7–5.4 years). Patients with low CFVR (<2.0; n = 20) showed reduced MACE-free survival (hazard ratio, 4.3; 95% CI, 2.2–8.4; P < .0001) and increased all-cause mortality (hazard ratio: 4.7; 95% CI: 2.0–11.3; P < .0001) compared with patients with high CFVR (≥2.0; n = 78). Worsened LVGLS (≥−15.5%) was also a strong independent predictor of MACE and cardiovascular and all-cause mortality. Combined low CFVR and worsened LVGLS provided incremental prognostic value, even after adjustment for CAV and time since HTx. The prevalence of low CFVR increased significantly with CAV severity, and the prevalence of combined low CFVR and/or worsened LVGLS was high in patients with moderate CAV (86%) and those with severe CAV (83%). The negative predictive value of combined high CFVR and improved LVGLS to rule out significant CAV was 94.5% (95% CI, 86.2%–98.4%), whereas the positive predictive value was 39.0% (95% CI, 25.3%–54.3%). The model had sensitivity of 84.2% (95% CI, 63.6%–95.3%) and specificity of 67.5% (95% CI, 56.6%–77.2%) for one or more abnormal parameters.

Conclusions

In HTx patients with severe CAV, a higher prevalence of low CFVR and worsened LVGLS was observed. Both measurements were strong independent predictors of MACE and all-cause mortality in HTx patients. Combined CFVR and LVGLS provided incremental prognostic value and showed an excellent ability to rule out significant CAV and may be considered as part of routine CAV surveillance of HTx patients.

中文翻译：

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冠状动脉血流速度储备和心肌变形预测心脏移植受者的长期结果

背景

心脏移植 (HTx) 后，侵入性冠状动脉造影是监测同种异体移植心脏血管病变 (CAV) 的金标准。无创 CAV 监测是可取的。作者检查了与 CAV 和 HTx 后预后相关的左心室整体纵向应变 (LVGLS) 和无创冠状动脉血流速度储备 (CFVR)。

方法

在 98 名 HTx 患者中评估了多普勒超声心动图 CFVR 和 LVGLS。记录了全因死亡率和主要不良心脏事件 (MACE)，包括因心力衰竭住院、心血管死亡和显着 CAV 进展。

结果

中位随访时间为 3.3 年（范围：1.7-5.4 年）。低 CFVR (<2.0；n  = 20) 的患者无 MACE 生存期降低（风险比，4.3；95% CI，2.2-8.4；P  < .0001）和全因死亡率增加（风险比：4.7；95 % CI：2.0–11.3；P  < .0001）与高 CFVR 患者（≥2.0；n = 78)。恶化的 LVGLS (≥-15.5%) 也是 MACE 和心血管和全因死亡率的强独立预测因子。即使在调整了 CAV 和自 HTx 以来的时间之后，低 CFVR 和恶化的 LVGLS 相结合提供了增加的预后价值。低 CFVR 的患病率随着 CAV 严重程度的增加而显着增加，在中度 CAV 患者（86%）和重度 CAV 患者（83%）中，低 CFVR 和/或 LVGLS 恶化的患病率较高。联合高 CFVR 和改善的 LVGLS 以排除显着 CAV 的阴性预测值为 94.5%（95% CI，86.2%–98.4%），而阳性预测值为 39.0%（95% CI，25.3%–54.3%） . 该模型对一项或多项异常参数的敏感性为 84.2%（95% CI，63.6%–95.3%），特异性为 67.5%（95% CI，56.6%–77.2%）。

结论

在患有严重 CAV 的 HTx 患者中，观察到低 CFVR 和恶化的 LVGLS 的患病率较高。两项测量都是 HTx 患者 MACE 和全因死亡率的强独立预测因子。联合 CFVR 和 LVGLS 提供了增加的预后价值，并显示出排除显着 CAV 的出色能力，可被视为 HTx 患者常规 CAV 监测的一部分。