title: Simultaneous assessment of fractional and coronary flow reserves in cardiac transplant recipients: Physiologic Investigation for Transplant Arteriopathy (PITA Study).
abstract: BACKGROUND
  The utility of measuring fractional flow reserve (FFR) to assess cardiac transplant arteriopathy has not been evaluated. Measuring coronary flow reserve (CFR) as well as FFR could add information about the microcirculation, but until recently, this has required two coronary wires. We evaluated a new method for simultaneously measuring FFR and CFR with a single wire to investigate transplant arteriopathy.
  
  
  RESULTS
  In 53 cases of asymptomatic cardiac transplant recipients without angiographically significant coronary disease, FFR and thermodilution-derived CFR (CFRthermo) were measured simultaneously with the same coronary pressure wire in the left anterior descending artery and compared with volumetric intravascular ultrasound (IVUS) imaging. The average FFR was 0.88+/-0.07; in 75% of cases, the FFR was less than the normal threshold of 0.94; and in 15% of cases, the FFR was < or =0.80, the upper boundary of the gray zone of the ischemic threshold. There was a significant inverse correlation between FFR and IVUS-derived measures of plaque burden, including percent plaque volume (r=0.55, P<0.0001). The average CFRthermo was 2.5+/-1.2; in 47% of cases, CFRthermo was < or =2.0. In 14%, the FFR was normal (> or =0.94) and the CFR was abnormal (<2.0), suggesting predominant microcirculatory dysfunction.
  
  
  CONCLUSIONS
  FFR correlates with IVUS findings and is abnormal in a significant proportion of asymptomatic cardiac transplant patients with normal angiograms. Simultaneous measurement of CFR with the same pressure wire, with the use of a novel coronary thermodilution technique, is feasible and adds information to the physiological evaluation of these patients.
authors.affiliation: Division of Cardiovascular Medicine, Stanford University Medical Center, 300 Pasteur Drive, Stanford, Calif 94305, USA. wfearon@stanford.edu
authors.forename: William F
authors.initials: WF
authors.lastname: Fearon
authors.forename: Mamoo
authors.initials: M
authors.lastname: Nakamura
authors.forename: David P
authors.initials: DP
authors.lastname: Lee
authors.forename: Mehrdad
authors.initials: M
authors.lastname: Rezaee
authors.forename: Randall H
authors.initials: RH
authors.lastname: Vagelos
authors.forename: Sharon A
authors.initials: SA
authors.lastname: Hunt
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Fitzgerald
authors.forename: Paul G
authors.initials: PG
authors.lastname: Yock
authors.forename: Alan C
authors.initials: AC
authors.lastname: Yeung
mesh_terms: D000792:Angiography; D006328:Cardiac Catheterization / Q000379:methods*; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000209:etiology; D003326:Coronary Circulation; D016027:Heart Transplantation / Q000009:adverse effects; D006801:Humans; D008833:Microcirculation; D013815:Thermodilution