title: Invasive Assessment of Coronary Physiology Predicts Late Mortality After Heart Transplantation.
abstract: The aim of this study is to determine the prognostic value of invasively assessing coronary physiology early after heart transplantation.
  
  
  
  Seventy-four cardiac transplant recipients had fractional flow reserve, coronary flow reserve, index of microcirculatory resistance (IMR), and intravascular ultrasound performed down the left anterior descending coronary artery soon after (baseline) and 1 year after heart transplantation. The primary end point was the cumulative survival free of death or retransplantation at a mean follow-up of 4.5±3.5 years. The cumulative event-free survival was significantly lower in patients with a fractional flow reserve <0.90 at baseline (42% versus 79%; P=0.01) or an IMR ≥20 measured 1 year after heart transplantation (39% versus 69%; P=0.03). Patients in whom IMR decreased or did not change from baseline to 1 year had higher event-free survival compared with patients with an increase in IMR (66% versus 36%; P=0.03). Fractional flow reserve <0.90 at baseline (hazard ratio, 0.13; 95% confidence interval, 0.02-0.81; P=0.03), IMR ≥20 at 1 year (hazard ratio, 3.93; 95% confidence interval, 1.08-14.27; P=0.04), and rejection during the first year (hazard ratio, 6.00; 95% confidence interval, 1.56-23.09; P=0.009) were independent predictors of death/retransplantation, whereas intravascular ultrasound parameters were not.
  
  
  
  Invasive measures of coronary physiology (fractional flow reserve and IMR) determined early after heart transplantation are significant predictors of late death or retransplantation.
authors.affiliation: From Stanford University, Stanford, CA (H.-M.Y., K.K., H.L., K.O., H.-S.L., Y.K., Y.H., A.C.Y., H.V., W.F.F.); and Ajou University School of Medicine, Suwon, South Korea (H.-M.Y., H.-S.L.).
authors.forename: Hyoung-Mo
authors.initials: HM
authors.lastname: Yang
authors.affiliation: From Stanford University, Stanford, CA (H.-M.Y., K.K., H.L., K.O., H.-S.L., Y.K., Y.H., A.C.Y., H.V., W.F.F.); and Ajou University School of Medicine, Suwon, South Korea (H.-M.Y., H.-S.L.).
authors.forename: Kiran
authors.initials: K
authors.lastname: Khush
authors.affiliation: From Stanford University, Stanford, CA (H.-M.Y., K.K., H.L., K.O., H.-S.L., Y.K., Y.H., A.C.Y., H.V., W.F.F.); and Ajou University School of Medicine, Suwon, South Korea (H.-M.Y., H.-S.L.).
authors.forename: Helen
authors.initials: H
authors.lastname: Luikart
authors.affiliation: From Stanford University, Stanford, CA (H.-M.Y., K.K., H.L., K.O., H.-S.L., Y.K., Y.H., A.C.Y., H.V., W.F.F.); and Ajou University School of Medicine, Suwon, South Korea (H.-M.Y., H.-S.L.).
authors.forename: Kozo
authors.initials: K
authors.lastname: Okada
authors.affiliation: From Stanford University, Stanford, CA (H.-M.Y., K.K., H.L., K.O., H.-S.L., Y.K., Y.H., A.C.Y., H.V., W.F.F.); and Ajou University School of Medicine, Suwon, South Korea (H.-M.Y., H.-S.L.).
authors.forename: Hong-Seok
authors.initials: HS
authors.lastname: Lim
authors.affiliation: From Stanford University, Stanford, CA (H.-M.Y., K.K., H.L., K.O., H.-S.L., Y.K., Y.H., A.C.Y., H.V., W.F.F.); and Ajou University School of Medicine, Suwon, South Korea (H.-M.Y., H.-S.L.).
authors.forename: Yuhei
authors.initials: Y
authors.lastname: Kobayashi
authors.affiliation: From Stanford University, Stanford, CA (H.-M.Y., K.K., H.L., K.O., H.-S.L., Y.K., Y.H., A.C.Y., H.V., W.F.F.); and Ajou University School of Medicine, Suwon, South Korea (H.-M.Y., H.-S.L.).
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Honda
authors.affiliation: From Stanford University, Stanford, CA (H.-M.Y., K.K., H.L., K.O., H.-S.L., Y.K., Y.H., A.C.Y., H.V., W.F.F.); and Ajou University School of Medicine, Suwon, South Korea (H.-M.Y., H.-S.L.).
authors.forename: Alan C
authors.initials: AC
authors.lastname: Yeung
authors.affiliation: From Stanford University, Stanford, CA (H.-M.Y., K.K., H.L., K.O., H.-S.L., Y.K., Y.H., A.C.Y., H.V., W.F.F.); and Ajou University School of Medicine, Suwon, South Korea (H.-M.Y., H.-S.L.).
authors.forename: Hannah
authors.initials: H
authors.lastname: Valantine
authors.affiliation: From Stanford University, Stanford, CA (H.-M.Y., K.K., H.L., K.O., H.-S.L., Y.K., Y.H., A.C.Y., H.V., W.F.F.); and Ajou University School of Medicine, Suwon, South Korea (H.-M.Y., H.-S.L.). wfearon@stanford.edu.
authors.forename: William F
authors.initials: WF
authors.lastname: Fearon
mesh_terms: D000328:Adult; D003326:Coronary Circulation / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D053805:Fractional Flow Reserve, Myocardial / Q000502:physiology*; D016027:Heart Transplantation / Q000401:mortality* / Q000639:trends; D006801:Humans; D008297:Male; D008833:Microcirculation / Q000502:physiology*; D055806:Microvessels / Q000502:physiology; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D011237:Predictive Value of Tests; D011446:Prospective Studies
keywords: heart transplantation; physiology; treatment outcome