PMID- 37890655
OWN - NLM
STAT- Publisher
LR  - 20231205
IS  - 1532-8414 (Electronic)
IS  - 1071-9164 (Linking)
DP  - 2023 Oct 27
TI  - Longitudinal Change and Predictors of Myocardial Flow Reserve by Positron 
      Emission Tomography for the Evaluation of Cardiac Allograft Vasculopathy 
      Following Heart Transplantation.
LID - S1071-9164(23)00377-9 [pii]
LID - 10.1016/j.cardfail.2023.09.013 [doi]
AB  - BACKGROUND: Positron emission tomography (PET) myocardial flow reserve (MFR) is a 
      noninvasive method of detecting cardiac allograft vasculopathy in recipients of 
      heart transplants (HTs). There are limited data on longitudinal change and 
      predictors of MFR following HT. METHODS: We conducted a retrospective analysis of 
      HT recipients undergoing PET myocardial perfusion imaging at an academic center. 
      Multivariable linear and Cox regression models were constructed to identify 
      longitudinal trends, predictors and the prognostic value of MFR after HT. 
      RESULTS: Of HT recipients, 183 underwent 658 PET studies. The average MFR was 
      2.34 +/- 0.70. MFR initially increased during the first 3 years following HT (+ 
      0.12 per year; P = 0.01) before beginning to decline at an annual rate of -0.06 
      per year (P < 0.001). MFR declines preceding acute rejection and improves after 
      treatment. Treatment with mammalian target of rapamycin (mTOR) inhibitors (37.2%) 
      slowed the rate of annual MFR decline (P = 0.03). Higher-intensity statin therapy 
      was associated with improved MFR. Longer time post-transplant (P < 0.001), 
      hypertension (P < 0.001), chronic kidney disease (P < 0.001), diabetes mellitus 
      (P = 0.038), antibody-mediated rejection (P = 0.040), and cytomegalovirus 
      infection (P = 0.034) were associated with reduced MFR. Reduced MFR (HR: 7.6, 95% 
      CI: 4.4-13.4; P < 0.001) and PET-defined ischemia (HR: 2.3, 95% CI: 1.4-3.9; P < 
      0.001) were associated with a higher risk of the composite outcome of mortality, 
      retransplantation, heart failure hospitalization, acute coronary syndrome, or 
      revascularization. CONCLUSION: MFR declines after the third post-transplant year 
      and is prognostic for cardiovascular events. Cardiometabolic risk-factor 
      modification and treatment with higher-intensity statin therapy and mechanistic 
      target of rapamycin inhibitors are associated with a higher MFR.
CI  - Copyright (c) 2023 Elsevier Inc. All rights reserved.
FAU - Gondi, Keerthi T
AU  - Gondi KT
AD  - Department of Internal Medicine, University of Michigan, Ann Arbor, MI. 
      Electronic address: keerthig@med.umich.edu.
FAU - Hammer, Yoav
AU  - Hammer Y
AD  - Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI.
FAU - Yosef, Matheos
AU  - Yosef M
AD  - Michigan Institute for Clinical and Health Research, University of Michigan, Ann 
      Arbor, MI.
FAU - Golbus, Jessica R
AU  - Golbus JR
AD  - Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI.
FAU - Madamanchi, Chaitanya
AU  - Madamanchi C
AD  - Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI.
FAU - Aaronson, Keith D
AU  - Aaronson KD
AD  - Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI.
FAU - Murthy, Venkatesh L
AU  - Murthy VL
AD  - Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI.
FAU - Konerman, Matthew C
AU  - Konerman MC
AD  - Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI.
LA  - eng
PT  - Journal Article
DEP - 20231027
PL  - United States
TA  - J Card Fail
JT  - Journal of cardiac failure
JID - 9442138
SB  - IM
OTO - NOTNLM
OT  - Heart transplantation
OT  - allograft rejection
OT  - cardiac allograft vasculopathy
OT  - myocardial flow reserve
OT  - positron emission tomography
OT  - statin
COIS- Disclosures JRG receives funding from the NIH (L30HL143700) and receives salary 
      support by an American Heart Association grant (#20SFRN35370008). VLM holds stock 
      in General Electric and Cardinal Health, has stock options and is scientific 
      advisor for Ionetix; receives research grants from Siemens and nonfinancial 
      research support from INVIA Medical Imaging Solutions. V.L.M. receives funding 
      from the NIH (U01DK123013; R01AG059729; R01HL136685), a Cardiometabolic Disease 
      Strategically Focused Research Network grant from the American Heart Association, 
      and the Melvyn Rubenfire Professorship in Preventive Cardiology; has stock in 
      General Electric and Cardinal Health; stock options and scientific advisor for 
      Ionetix; research grants from Siemens; paid consultant for INVIA Medical Imaging 
      Solutions. All other authors have no real or perceived conflicts of interest.
EDAT- 2023/10/28 11:42
MHDA- 2023/10/28 11:42
CRDT- 2023/10/27 19:29
PHST- 2022/11/20 00:00 [received]
PHST- 2023/09/16 00:00 [revised]
PHST- 2023/09/19 00:00 [accepted]
PHST- 2023/10/28 11:42 [pubmed]
PHST- 2023/10/28 11:42 [medline]
PHST- 2023/10/27 19:29 [entrez]
AID - S1071-9164(23)00377-9 [pii]
AID - 10.1016/j.cardfail.2023.09.013 [doi]
PST - aheadofprint
SO  - J Card Fail. 2023 Oct 27:S1071-9164(23)00377-9. doi: 
      10.1016/j.cardfail.2023.09.013.