Coronary Flow Evaluation in Heart Transplant Patients Compared to Healthy Controls Documents the Superiority of Coronary Flow Velocity Reserve Companion as Diagnostic and Prognostic Tool
BackgroundDistinct contributions by functional or structural alterations of coronary microcirculation in heart transplantation (HT) and their prognostic role have not been fully elucidated. We aimed to identify the mechanisms of coronary microvascular dysfunction (CMD) in HT and their prognostic imp...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2022-06-01
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| Series: | Frontiers in Cardiovascular Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2022.887370/full |
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| author | Annagrazia Cecere Peter L. M. Kerkhof Giovanni Civieri Annalisa Angelini Antonio Gambino Angela Fraiese Tomaso Bottio Elena Osto Elena Osto Giulia Famoso Marny Fedrigo Enrico Giacomin Giuseppe Toscano Roberta Montisci Sabino Iliceto Gino Gerosa Francesco Tona |
| author_facet | Annagrazia Cecere Peter L. M. Kerkhof Giovanni Civieri Annalisa Angelini Antonio Gambino Angela Fraiese Tomaso Bottio Elena Osto Elena Osto Giulia Famoso Marny Fedrigo Enrico Giacomin Giuseppe Toscano Roberta Montisci Sabino Iliceto Gino Gerosa Francesco Tona |
| author_sort | Annagrazia Cecere |
| collection | DOAJ |
| description | BackgroundDistinct contributions by functional or structural alterations of coronary microcirculation in heart transplantation (HT) and their prognostic role have not been fully elucidated. We aimed to identify the mechanisms of coronary microvascular dysfunction (CMD) in HT and their prognostic implications.Methods134 patients, surviving at least 5 years after HT, without evidence of angiographic vasculopathy or symptoms/signs of rejection were included. 50 healthy volunteers served as controls. All underwent the assessment of rest and hyperemic coronary diastolic peak flow velocity (DPVr and DPVh) and coronary flow velocity reserve (CFVR) and its inherent companion that is based on the adjusted quadratic mean: CCFVR = √{(DPVr)2 + (DPVh)2}. Additionally, basal and hyperemic coronary microvascular resistance (BMR and HMR) were estimated.ResultsBased on CFVR and DPVh, HT patients can be assigned to four endotypes: endotype 1, discordant with preserved CFVR (3.1 ± 0.4); endotype 2, concordant with preserved CFVR (3.4 ± 0.5); endotype 3, concordant with impaired CFVR (1.8 ± 0.3) and endotype 4, discordant with impaired CFVR (2.0 ± 0.2). Intriguingly, endotype 1 showed lower DPVr (p < 0.0001) and lower DPVh (p < 0.0001) than controls with lower CFVR (p < 0.0001) and lower CCFVR (p < 0.0001) than controls. Moreover, both BMR and HMR were higher in endotype 1 than in controls (p = 0.001 and p < 0.0001, respectively), suggesting structural microvascular remodeling. Conversely, endotype 2 was comparable to controls. A 13/32 (41%) patients in endotype 1 died in a follow up of 28 years and mortality rate was comparable to endotype 3 (14/31, 45%). However, CCFVR was < 80 cm/s in all 13 deaths of endotype 1 (characterized by preserved CFVR). At multivariable analysis, CMD, DPVh < 75 cm/s and CCFVR < 80 cm/s were independent predictors of mortality. The inclusion of CCFVR < 80 cm/s to models with clinical indicators of mortality better predicted survival, compared to only adding CMD or DPVh < 75 cm/s (p < 0.0001 and p = 0.03, respectively).ConclusionA normal CFVR could hide detection of microvasculopathy with high flow resistance and low flow velocities at rest. This microvasculopathy seems to be secondary to factors unrelated to HT (less rejections and more often diabetes). The combined use of CFVR and CCFVR provides more complete clinical and prognostic information on coronary microvasculopathy in HT. |
| first_indexed | 2024-12-12T07:27:54Z |
| format | Article |
| id | doaj.art-401a3bf4ca4b41a5bac0b4d5f1fdb5fe |
| institution | Directory Open Access Journal |
| issn | 2297-055X |
| language | English |
| last_indexed | 2024-12-12T07:27:54Z |
| publishDate | 2022-06-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj.art-401a3bf4ca4b41a5bac0b4d5f1fdb5fe2022-12-22T00:33:06ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2022-06-01910.3389/fcvm.2022.887370887370Coronary Flow Evaluation in Heart Transplant Patients Compared to Healthy Controls Documents the Superiority of Coronary Flow Velocity Reserve Companion as Diagnostic and Prognostic ToolAnnagrazia Cecere0Peter L. M. Kerkhof1Giovanni Civieri2Annalisa Angelini3Antonio Gambino4Angela Fraiese5Tomaso Bottio6Elena Osto7Elena Osto8Giulia Famoso9Marny Fedrigo10Enrico Giacomin11Giuseppe Toscano12Roberta Montisci13Sabino Iliceto14Gino Gerosa15Francesco Tona16Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, ItalyDepartment of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, NetherlandsDepartment of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, ItalyCardiovascular Pathology Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, ItalyDivision of Cardiac Surgery, University of Padua, Padua, ItalyDivision of Cardiac Surgery, University of Padua, Padua, ItalyDivision of Cardiac Surgery, University of Padua, Padua, ItalyCardiology, University Heart Center, University Hospital of Zürich, Zurich, SwitzerlandInstitute of Clinical Chemistry, University of Zurich, University Hospital of Zürich, Zurich, SwitzerlandDepartment of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, ItalyCardiovascular Pathology Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, ItalyDepartment of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, ItalyDivision of Cardiac Surgery, University of Padua, Padua, ItalyClinical Cardiology, AOU Cagliari, Department of Medical Science and Public Health, University of Cagliari, Cagliari, ItalyDepartment of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, ItalyDivision of Cardiac Surgery, University of Padua, Padua, ItalyDepartment of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, ItalyBackgroundDistinct contributions by functional or structural alterations of coronary microcirculation in heart transplantation (HT) and their prognostic role have not been fully elucidated. We aimed to identify the mechanisms of coronary microvascular dysfunction (CMD) in HT and their prognostic implications.Methods134 patients, surviving at least 5 years after HT, without evidence of angiographic vasculopathy or symptoms/signs of rejection were included. 50 healthy volunteers served as controls. All underwent the assessment of rest and hyperemic coronary diastolic peak flow velocity (DPVr and DPVh) and coronary flow velocity reserve (CFVR) and its inherent companion that is based on the adjusted quadratic mean: CCFVR = √{(DPVr)2 + (DPVh)2}. Additionally, basal and hyperemic coronary microvascular resistance (BMR and HMR) were estimated.ResultsBased on CFVR and DPVh, HT patients can be assigned to four endotypes: endotype 1, discordant with preserved CFVR (3.1 ± 0.4); endotype 2, concordant with preserved CFVR (3.4 ± 0.5); endotype 3, concordant with impaired CFVR (1.8 ± 0.3) and endotype 4, discordant with impaired CFVR (2.0 ± 0.2). Intriguingly, endotype 1 showed lower DPVr (p < 0.0001) and lower DPVh (p < 0.0001) than controls with lower CFVR (p < 0.0001) and lower CCFVR (p < 0.0001) than controls. Moreover, both BMR and HMR were higher in endotype 1 than in controls (p = 0.001 and p < 0.0001, respectively), suggesting structural microvascular remodeling. Conversely, endotype 2 was comparable to controls. A 13/32 (41%) patients in endotype 1 died in a follow up of 28 years and mortality rate was comparable to endotype 3 (14/31, 45%). However, CCFVR was < 80 cm/s in all 13 deaths of endotype 1 (characterized by preserved CFVR). At multivariable analysis, CMD, DPVh < 75 cm/s and CCFVR < 80 cm/s were independent predictors of mortality. The inclusion of CCFVR < 80 cm/s to models with clinical indicators of mortality better predicted survival, compared to only adding CMD or DPVh < 75 cm/s (p < 0.0001 and p = 0.03, respectively).ConclusionA normal CFVR could hide detection of microvasculopathy with high flow resistance and low flow velocities at rest. This microvasculopathy seems to be secondary to factors unrelated to HT (less rejections and more often diabetes). The combined use of CFVR and CCFVR provides more complete clinical and prognostic information on coronary microvasculopathy in HT.https://www.frontiersin.org/articles/10.3389/fcvm.2022.887370/fullcoronary flow reservemicrocirculationheart transplantcompanion metricprognosis |
| spellingShingle | Annagrazia Cecere Peter L. M. Kerkhof Giovanni Civieri Annalisa Angelini Antonio Gambino Angela Fraiese Tomaso Bottio Elena Osto Elena Osto Giulia Famoso Marny Fedrigo Enrico Giacomin Giuseppe Toscano Roberta Montisci Sabino Iliceto Gino Gerosa Francesco Tona Coronary Flow Evaluation in Heart Transplant Patients Compared to Healthy Controls Documents the Superiority of Coronary Flow Velocity Reserve Companion as Diagnostic and Prognostic Tool Frontiers in Cardiovascular Medicine coronary flow reserve microcirculation heart transplant companion metric prognosis |
| title | Coronary Flow Evaluation in Heart Transplant Patients Compared to Healthy Controls Documents the Superiority of Coronary Flow Velocity Reserve Companion as Diagnostic and Prognostic Tool |
| title_full | Coronary Flow Evaluation in Heart Transplant Patients Compared to Healthy Controls Documents the Superiority of Coronary Flow Velocity Reserve Companion as Diagnostic and Prognostic Tool |
| title_fullStr | Coronary Flow Evaluation in Heart Transplant Patients Compared to Healthy Controls Documents the Superiority of Coronary Flow Velocity Reserve Companion as Diagnostic and Prognostic Tool |
| title_full_unstemmed | Coronary Flow Evaluation in Heart Transplant Patients Compared to Healthy Controls Documents the Superiority of Coronary Flow Velocity Reserve Companion as Diagnostic and Prognostic Tool |
| title_short | Coronary Flow Evaluation in Heart Transplant Patients Compared to Healthy Controls Documents the Superiority of Coronary Flow Velocity Reserve Companion as Diagnostic and Prognostic Tool |
| title_sort | coronary flow evaluation in heart transplant patients compared to healthy controls documents the superiority of coronary flow velocity reserve companion as diagnostic and prognostic tool |
| topic | coronary flow reserve microcirculation heart transplant companion metric prognosis |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2022.887370/full |
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