Background: Cardiac allograft vasculopathy (CAV) is a leading cause of death and retransplantation
following heart transplantation (HTX). Surveillance angiography performed yearly is
indicated for the early detection of the disease, but it remains of limited sensitivity.
Methods: We performed bolus thermodilution-based coronary flow reserve (CFR) and index
of microcirculatory resistance (IMR) and fractional flow reserve (FFR) measurements
in HTX patients undergoing yearly surveillance coronary angiography without overt
CAV. Results: In total, 27 HTX patients were included who had 52 CFR, IMR, and FFR
measurements at a mean of 43 months after HTX. Only five measurements were performed
in the first year. CFR decreased significantly by 0.13 every year (p = 0.04) and IMR
tended to increase by 0.98 every year (p = 0.051), whereas FFR did not change (p =
0.161) and remained well above 0.80 over time. After one year, CFR decreased significantly
(p = 0.022) and IMR increased significantly (p = 0.015), whereas FFR remained unchanged
(p = 0.72). Conclusions: The functional status of the epicardial coronary arteries
of transplanted hearts did not deteriorate over time. On the contrary, a significant
decrease in CFR was noted. In view of the increasing IMR, this is caused by the deterioration
of the function of microvasculature. CFR and IMR measurements may provide an early
opportunity to diagnose CAV.
