Long-term prognostic value of invasive and non-invasive measures early after heart transplantation.

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Abstract

Invasively assessed coronary microvascular resistance early after heart transplantation predicts worse long-term outcome; however, little is known about the relationship between microvascular resistance, left ventricular function and outcomes in this setting.A total of 100 cardiac transplant recipients had fractional flow reserve (FFR) and the index of microcirculatory resistance (IMR) measured in the left anterior descending artery and echocardiographic assessment of left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS) at 1?year after heart transplantation. The primary endpoint was the composite of death and retransplantation occurring beyond the first post-operative year.The mean FFR, IMR, LVEF, and GLS values at 1?year were 0.87?±?0.06, 21.3?±?17.3, 60.4?±?5.4%, and 14.2?±?2.4%, respectively. FFR and IMR had no significant correlation with LVEF and GLS. During a mean follow-up of 6.7?±?4.2?years, the primary endpoint occurred in 24 patients (24.0%). By ROC curve analysis, IMR?=?19.3 and GLS?=?13.3% were the best cutoff values for predicting death or retransplantation. Cumulative event-free survival was significantly lower in patients with higher IMR (log-rank p?=?0.02) and lower GLS (log-rank p?

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