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Shahandeh N, Song J, Saito K, Honda Y, Zimmermann FM, Ahn JM, Fearon WF, Parikh RV. Invasive Coronary Physiology in Heart Transplant Recipients: State-of-the-Art Review. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2023; 2:100627. [PMID: 39130712 PMCID: PMC11307478 DOI: 10.1016/j.jscai.2023.100627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 02/02/2023] [Accepted: 02/28/2023] [Indexed: 08/13/2024]
Abstract
Cardiac allograft vasculopathy is a leading cause of allograft failure and death among heart transplant recipients. Routine coronary angiography and intravascular ultrasound in the early posttransplant period are widely accepted as the current standard-of-care diagnostic modalities. However, many studies have now demonstrated that invasive coronary physiological assessment provides complementary long-term prognostic data and helps identify patients who are at risk of accelerated cardiac allograft vasculopathy and acute rejection.
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Affiliation(s)
- Negeen Shahandeh
- Division of Cardiology, Department of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Justin Song
- Division of Cardiology, Department of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Kan Saito
- Division of Cardiovascular Medicine, Stanford University, Stanford, California
| | - Yasuhiro Honda
- Division of Cardiovascular Medicine, Stanford University, Stanford, California
| | | | - Jung-Min Ahn
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - William F. Fearon
- Division of Cardiovascular Medicine, Stanford University and VA Palo Alto Health Care Systems, Stanford, California
| | - Rushi V. Parikh
- Division of Cardiology, Department of Medicine, University of California, Los Angeles, Los Angeles, California
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Safety of Right and Left Ventricular Endomyocardial Biopsy in Heart Transplantation And Cardiomyopathy Patients. JACC: HEART FAILURE 2022; 10:963-973. [DOI: 10.1016/j.jchf.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 08/08/2022] [Accepted: 08/11/2022] [Indexed: 11/06/2022]
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Shahandeh N, Kashiyama K, Honda Y, Nsair A, Ali ZA, Tobis JM, Fearon WF, Parikh RV. Invasive Coronary Imaging Assessment for Cardiac Allograft Vasculopathy: State-of-the-Art Review. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2022; 1:100344. [PMID: 39131933 PMCID: PMC11307976 DOI: 10.1016/j.jscai.2022.100344] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 04/07/2022] [Accepted: 04/17/2022] [Indexed: 08/13/2024]
Abstract
Heart transplantation is the standard of care treatment for end-stage heart failure. Therapeutic advances including enhanced immunosuppression and aggressive infectious prophylaxis have led to increased life-expectancy following transplantation; however, cardiac allograft vasculopathy (CAV) remains a leading cause of morbidity and mortality. Although coronary angiography is the current guideline-recommended diagnostic modality for invasive CAV screening, it is limited in its ability to detect early and/or diffuse disease. Efforts to improve outcomes for heart transplant recipients with CAV have focused on developing diagnostic tools with greater sensitivity to capture early CAV in order to better understand the pathobiology and implement treatment to slow disease progression sooner after transplant. The contemporary invasive imaging armamentarium for CAV surveillance includes coronary angiography, intravascular ultrasound, and newer technologies including optical coherence tomography and near-infrared spectroscopy. The present review outlines the use of and data in support of these imaging platforms in the CAV arena and highlights the potential advantages and limitations of each of these modalities.
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Affiliation(s)
- Negeen Shahandeh
- Division of Cardiology, University of California Los Angeles, Los Angeles, California
| | - Kuninobu Kashiyama
- Division of Cardiovascular Medicine, Stanford University, Stanford, California
| | - Yasuhiro Honda
- Division of Cardiovascular Medicine, Stanford University, Stanford, California
| | - Ali Nsair
- Division of Cardiology, University of California Los Angeles, Los Angeles, California
| | - Ziad A. Ali
- DeMatteis Cardiovascular Institute, St Francis Hospital & Heart Center, Roslyn, New York
- Cardiovascular Research Foundation, New York, New York
| | - Jonathan M. Tobis
- Division of Cardiology, University of California Los Angeles, Los Angeles, California
| | - William F. Fearon
- Division of Cardiovascular Medicine, Stanford University and VA Palo Alto Health Care Systems, Stanford, California
| | - Rushi V. Parikh
- Division of Cardiology, University of California Los Angeles, Los Angeles, California
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Mileva N, Nagumo S, Gallinoro E, Sonck J, Verstreken S, Dierkcx R, Heggermont W, Bartunek J, Goethals M, Heyse A, Barbato E, De Bruyne B, Collet C, Vanderheyden M. Validation of Coronary Angiography-Derived Vessel Fractional Flow Reserve in Heart Transplant Patients with Suspected Graft Vasculopathy. Diagnostics (Basel) 2021; 11:diagnostics11101750. [PMID: 34679451 PMCID: PMC8534544 DOI: 10.3390/diagnostics11101750] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/20/2021] [Accepted: 09/22/2021] [Indexed: 01/06/2023] Open
Abstract
Cardiac transplant-related vasculopathy remains a leading cause of morbidity and mortality in heart transplant (HTx) recipients. Recently, coronary angiography-derived vessel fractional flow reserve (vFFR) has emerged as a new diagnostic computational tool to functionally evaluate the severity of coronary artery disease. Although vFFR estimates have been shown to perform well against invasive FFR in atherosclerotic coronary artery disease, data on the use of vFFR in heart transplant recipients suffering from cardiac transplant-related arteriopathy are lacking. The aim of the presented study was to validate coronary angiography-derived vessel fractional flow reserve to calculate fractional flow reserve in HTx patients with and without cardiac transplant-related vasculopathy. A prospective, single center study of HTx patients referred for annual check-up, undergoing surveillance coronarography was conducted. Invasive FFR was measured using a motorized device at the speed of 1.0 mm/s in all three major coronary arteries. Angiography-derived pullback FFR was derived from the angiogram and compared with invasive FFR pullback curve. Overall, 18,059 FFR values were extracted from the FFR pullback curves from 23 HTx patients. The mean age was 59.3 ± 9.7 years, the mean time after transplantation was 5.24 years [IQR 1.20, 11.25]. A total of 39 vessels from 23 patients (24 LAD, 11 LCX, 4 RCA) were analyzed. Mean distal vFFR was 0.87 ± 0.14 whereas invasive distal FFR was 0.88 ± 0.17. An excellent correlation was found between invasive distal FFR and vFFR (r = 0.92; p < 0.001). The correlation of the pullback tracing was high, with a correlation coefficient between vFFR and invasive FFR pullback values of 0.72 (95% CI 0.71 to 0.73, p < 0.001). The mean difference between vFFR and invasive FFR pullback values was -0.01 with 0.06 of SD (limits of agreements -0.12 to 0.13). In HTx patients, coronary angiography-derived FFR correlates excellently with invasively measured wire-derived FFR. Therefore, angiography derived FFR could be used as a novel diagnostic tool to quantify the functional severity of graft vasculopathy.
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Affiliation(s)
- Niya Mileva
- Cardiovascular Center Aalst, OLV Clinic, 9300 Aalst, Belgium; (N.M.); (S.N.); (E.G.); (J.S.); (S.V.); (R.D.); (W.H.); (J.B.); (M.G.); (A.H.); (E.B.); (B.D.B.); (C.C.)
- Cardiology Clinic, Alexandrovska University Hospital, 1430 Sofia, Bulgaria
| | - Sakura Nagumo
- Cardiovascular Center Aalst, OLV Clinic, 9300 Aalst, Belgium; (N.M.); (S.N.); (E.G.); (J.S.); (S.V.); (R.D.); (W.H.); (J.B.); (M.G.); (A.H.); (E.B.); (B.D.B.); (C.C.)
- Department of Cardiology, Showa University Fujigaoka Hospital, Tokyo 8501, Japan
| | - Emanuele Gallinoro
- Cardiovascular Center Aalst, OLV Clinic, 9300 Aalst, Belgium; (N.M.); (S.N.); (E.G.); (J.S.); (S.V.); (R.D.); (W.H.); (J.B.); (M.G.); (A.H.); (E.B.); (B.D.B.); (C.C.)
- Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, 81100 Naples, Italy
| | - Jeroen Sonck
- Cardiovascular Center Aalst, OLV Clinic, 9300 Aalst, Belgium; (N.M.); (S.N.); (E.G.); (J.S.); (S.V.); (R.D.); (W.H.); (J.B.); (M.G.); (A.H.); (E.B.); (B.D.B.); (C.C.)
- Department of Advanced Biomedical Sciences, University Federico II, 80131 Naples, Italy
| | - Sofie Verstreken
- Cardiovascular Center Aalst, OLV Clinic, 9300 Aalst, Belgium; (N.M.); (S.N.); (E.G.); (J.S.); (S.V.); (R.D.); (W.H.); (J.B.); (M.G.); (A.H.); (E.B.); (B.D.B.); (C.C.)
| | - Riet Dierkcx
- Cardiovascular Center Aalst, OLV Clinic, 9300 Aalst, Belgium; (N.M.); (S.N.); (E.G.); (J.S.); (S.V.); (R.D.); (W.H.); (J.B.); (M.G.); (A.H.); (E.B.); (B.D.B.); (C.C.)
| | - Ward Heggermont
- Cardiovascular Center Aalst, OLV Clinic, 9300 Aalst, Belgium; (N.M.); (S.N.); (E.G.); (J.S.); (S.V.); (R.D.); (W.H.); (J.B.); (M.G.); (A.H.); (E.B.); (B.D.B.); (C.C.)
| | - Jozef Bartunek
- Cardiovascular Center Aalst, OLV Clinic, 9300 Aalst, Belgium; (N.M.); (S.N.); (E.G.); (J.S.); (S.V.); (R.D.); (W.H.); (J.B.); (M.G.); (A.H.); (E.B.); (B.D.B.); (C.C.)
| | - Marc Goethals
- Cardiovascular Center Aalst, OLV Clinic, 9300 Aalst, Belgium; (N.M.); (S.N.); (E.G.); (J.S.); (S.V.); (R.D.); (W.H.); (J.B.); (M.G.); (A.H.); (E.B.); (B.D.B.); (C.C.)
| | - Alex Heyse
- Cardiovascular Center Aalst, OLV Clinic, 9300 Aalst, Belgium; (N.M.); (S.N.); (E.G.); (J.S.); (S.V.); (R.D.); (W.H.); (J.B.); (M.G.); (A.H.); (E.B.); (B.D.B.); (C.C.)
| | - Emanuele Barbato
- Cardiovascular Center Aalst, OLV Clinic, 9300 Aalst, Belgium; (N.M.); (S.N.); (E.G.); (J.S.); (S.V.); (R.D.); (W.H.); (J.B.); (M.G.); (A.H.); (E.B.); (B.D.B.); (C.C.)
- Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, 81100 Naples, Italy
| | - Bernard De Bruyne
- Cardiovascular Center Aalst, OLV Clinic, 9300 Aalst, Belgium; (N.M.); (S.N.); (E.G.); (J.S.); (S.V.); (R.D.); (W.H.); (J.B.); (M.G.); (A.H.); (E.B.); (B.D.B.); (C.C.)
- Department of Cardiology, Lausanne University Hospital, 1100 Lausanne, Switzerland
| | - Carlos Collet
- Cardiovascular Center Aalst, OLV Clinic, 9300 Aalst, Belgium; (N.M.); (S.N.); (E.G.); (J.S.); (S.V.); (R.D.); (W.H.); (J.B.); (M.G.); (A.H.); (E.B.); (B.D.B.); (C.C.)
| | - Marc Vanderheyden
- Cardiovascular Center Aalst, OLV Clinic, 9300 Aalst, Belgium; (N.M.); (S.N.); (E.G.); (J.S.); (S.V.); (R.D.); (W.H.); (J.B.); (M.G.); (A.H.); (E.B.); (B.D.B.); (C.C.)
- Correspondence: ; Tel.: +32-53-72-44-39
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