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Ahn JM, Zimmermann FM, Gullestad L, et al. Microcirculatory Resistance Predicts Allograft Rejection and Cardiac Events After Heart Transplantation. J Am Coll Cardiol. 2021;78(24):2425-2435doi: 10.1016/j.jacc.2021.10.009.
Ahn, J. M., Zimmermann, F. M., Gullestad, L., Angerås, O., Karason, K., Russell, K., Lunde, K., Okada, K., Luikart, H., Khush, K. K., Honda, Y., Pijls, N. H. J., Lee, S. E., Kim, J. J., Park, S. J., Solberg, O. G., & Fearon, W. F. (2021). Microcirculatory Resistance Predicts Allograft Rejection and Cardiac Events After Heart Transplantation. Journal of the American College of Cardiology, 78(24), 2425-2435. https://doi.org/10.1016/j.jacc.2021.10.009
Ahn, Jung-Min, et al. "Microcirculatory Resistance Predicts Allograft Rejection and Cardiac Events After Heart Transplantation." Journal of the American College of Cardiology vol. 78,24 (2021): 2425-2435. doi: https://doi.org/10.1016/j.jacc.2021.10.009
Ahn JM, Zimmermann FM, Gullestad L, Angerås O, Karason K, Russell K, Lunde K, Okada K, Luikart H, Khush KK, Honda Y, Pijls NHJ, Lee SE, Kim JJ, Park SJ, Solberg OG, Fearon WF. Microcirculatory Resistance Predicts Allograft Rejection and Cardiac Events After Heart Transplantation. J Am Coll Cardiol. 2021 Dec 14;78(24):2425-2435. doi: 10.1016/j.jacc.2021.10.009. PMID: 34886963.
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J Am Coll Cardiol. 2021 Dec 14;78(24):2425-2435. doi: 10.1016/j.jacc.2021.10.009.

Microcirculatory Resistance Predicts Allograft Rejection and Cardiac Events After Heart Transplantation.

Journal of the American College of Cardiology

Jung-Min Ahn, Frederik M Zimmermann, Lars Gullestad, Oskar Angerås, Kristjan Karason, Kristoffer Russell, Ketil Lunde, Kozo Okada, Helen Luikart, Kiran K Khush, Yasuhiro Honda, Nico H J Pijls, Sang Eun Lee, Jae-Joong Kim, Seung-Jung Park, Ole-Geir Solberg, William F Fearon

Affiliations

  1. Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea; Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford Cardiovascular Institute, Stanford, California, USA.
  2. Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford Cardiovascular Institute, Stanford, California, USA; Catharina Hospital, Eindhoven, the Netherlands.
  3. Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway; KG Jebsen Center for Cardiac Research, University of Oslo, Norway; Center for Heart Failure Research, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
  4. Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg University, Gothenburg, Sweden.
  5. Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway.
  6. Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan.
  7. Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford Cardiovascular Institute, Stanford, California, USA.
  8. Catharina Hospital, Eindhoven, the Netherlands.
  9. Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
  10. Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford Cardiovascular Institute, Stanford, California, USA; VA Palo Alto Health Care System, California, USA. Electronic address: [email protected].

PMID: 34886963 DOI: 10.1016/j.jacc.2021.10.009

Abstract

BACKGROUND: Single-center data suggest that the index of microcirculatory resistance (IMR) measured early after heart transplantation predicts subsequent acute rejection.

OBJECTIVES: The goal of this study was to validate whether IMR measured early after transplantation can predict subsequent acute rejection and long-term outcome in a large multicenter cohort.

METHODS: From 5 international cohorts, 237 patients who underwent IMR measurement early after transplantation were enrolled. The primary outcome was acute allograft rejection (AAR) within 1 year after transplantation. A key secondary outcome was major adverse cardiac events (MACE) (the composite of death, re-transplantation, myocardial infarction, stroke, graft dysfunction, and readmission) at 10 years.

RESULTS: IMR was measured at a median of 7 weeks (interquartile range: 3-10 weeks) post-transplantation. At 1 year, the incidence of AAR was 14.4%. IMR was associated proportionally with the risk of AAR (per increase of 1-U IMR; adjusted hazard ratio [aHR]: 1.04; 95% confidence interval [CI]: 1.02-1.06; p < 0.001). The incidence of AAR in patients with an IMR ≥18 was 23.8%, whereas the incidence of AAR in those with an IMR <18 was 6.3% (aHR: 3.93; 95% CI: 1.77-8.73; P = 0.001). At 10 years, MACE occurred in 86 (36.3%) patients. IMR was significantly associated with the risk of MACE (per increase of 1-U IMR; aHR: 1.02; 95% CI: 1.01-1.04; P = 0.005).

CONCLUSIONS: IMR measured early after heart transplantation is associated with subsequent AAR at 1 year and clinical events at 10 years. Early IMR measurement after transplantation identifies patients at higher risk and may guide personalized posttransplantation management.

Published by Elsevier Inc.

Keywords: heart transplantation; index of microcirculatory resistance; microvascular dysfunction; personalized management; prognosis; rejection

Conflict of interest statement

Funding Support and Author Disclosures Dr Angerås has received research grant, speaker fees, and personal fees from Abbott Vascular. All other authors have reported that they have no relationships rel

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