CT-derived fractional flow reserve (FFRct) for functional coronary artery evaluation in the follow-up of patients after heart transplantation

Ricardo P. J. Budde*, Fay M. A. Nous, Stefan Roest, Alina A. Constantinescu, Koen Nieman, Jasper J. Brugts, Lynne M. Koweek, Alexander Hirsch, Jonathon Leipsic, Olivier C. Manintveld

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

Objectives Invasively measured fractional fow reserve (FFR) is associated with outcome in heart transplant (HTx) patients.
Coronary computed tomography angiography (CCTA)–derived FFR (FFRct) provides additional functional information
from anatomical CT images. We describe the frst use of FFRct in HTx patients.
Methods HTx patients underwent CCTA with FFRct to screen for cardiac allograft vasculopathy. FFRct was measured distal
to each coronary stenosis>30% and FFRct≤0.8 indicated hemodynamically signifcant stenosis. FFRct was also measured
at the most distal location of each vessel. Overall distal FFRct was calculated as the mean of the distal values in the left,
right, and circumfex coronary artery in each patient.
Results Seventy-three patients (age 56 (42–65) years, 63% males) at 11 (8–16) years after HTx were included. Eighteen (25%)
patients had a focal hemodynamically signifcant stenosis (stenosis>30% with FFRct≤0.8). In the 55 patients without a hemodynamically signifcant focal FFRct stenosis (FFRct>0.80), the distal left anterior descending artery FFRct was<0.90 in 74%
of the patients and 10 (18%) patients had≥1 coronary artery with a distal FFRct≤0.8, including 1 with a distal FFRct≤0.8
in all coronaries. Overall distal FFRct in patients without focal stenosis was 0.88 (0.86–0.91), 0.87 (0.86–0.90), and 0.88
(0.86–0.91) (median with 25th–75th percentile) at 5–9, 10–14, or≥15 years post-transplantation, respectively (p=0.93).
Conclusions FFRct performed on CCTA scans of HTx patients demonstrated that 25% of patients had a focal coronary
stenosis with FFRct≤0.8. Even without a focal stenosis, FFRct values are often abnormal in HTx patients.
Key Points
• This is the frst report describing the use of FFRct in in heart transplant patients.
• FFRct identifes patients after heart transplantation with hemodynamically signifcant coronary stenosis.
• Even without a focal stenosis, FFRct values are often abnormal in heart transplant patients.
Original languageEnglish
Pages (from-to)1843-1852
Number of pages10
JournalEuropean Radiology
Volume32
Issue number3
Early online date15 Sep 2021
DOIs
Publication statusPublished - 2022

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