Coronary Microcirculatory Dysfunction and Acute Cellular Rejection After Heart Transplantation

• DOI: 10.1161/circulationaha.121.056158
• Publication Date: 2021-09-03T09:22:05Z
• Authors: Joo Myung Lee; Ki Hong Choi; Jin-Oh Choi; Doosup Shin; Yoonjee Park; Juwon Kim; Seung Hun Lee; Darae Kim; Jeong Hoon Yang; Yang Hyun Cho; Kiick Sung; Ji Yeon Choi; Meesoon Park; Jung-Sun Kim; Taek Kyu Park; Young Bin Song; Joo-Yong Hahn; Seung-Hyuk Choi; Hyeon-Cheol Gwon; Jae K. Oh; Eun-Seok Jeon
• Keywords: Male; 03 medical and health sciences; 0302 clinical medicine; Heart Diseases; Microcirculation; Heart Transplantation; Humans; Female; Prospective Studies; Middle Aged; 3. Good health

Background: Acute cellular rejection is a major determinant of mortality and retransplantation after heart transplantation. We sought to evaluate the prognostic implications coronary microcirculatory dysfunction assessed by index resistance (IMR) for risk acute Methods: The present study prospectively enrolled 154 transplant recipients who underwent scheduled angiography invasive physiological assessment 1 month IMR under maximal hyperemia. By measuring hyperemic mean transit time using 3 injections (4 mL each) room-temperature saline hyperemia, was calculated as distal pressure×hyperemic time. primary end point biopsy-proven grade ≥2R during 2 years follow-up transplantation compared multivariable Cox proportional hazards regression according IMR. incremental value IMR, in addition model with clinical factors, evaluated comparison C-index, net reclassification index, integrated discrimination index. Results: age 51.2±13.1 (81.2% male), cumulative incidence 19.0% at years. Patients had significantly higher values than those without (23.1±8.6 versus 16.8±11.1, P =0.002). associated (per 5-U increase: adjusted hazard ratio, 1.18 [95% CI, 1.04–1.34], =0.011) optimal cutoff predict 15. IMR≥15 showed IMR<15 (34.4% 3.8%; 15.3 CI 3.6–65.7], <0.001). Addition variables discriminant ability (C-index 0.87 0.74, <0.001; 1.05, 0.20, Conclusions: Coronary measured early significant association rejection. In surveillance endomyocardial biopsy, stratification could be clinically useful tool identify patients future Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02798731.