BACKGROUND Microvascular dysfunction after heart transplantation leads to restrictive cardiac allograft physiology (RCP), which is classified as severe coronary allograft vasculopathy (CAV); however, the prognosis of RCP remains unclear. Therefore, in this study, we aimed to elucidate the prognosis of RCP in comparison with that of severe angiographic CAV. METHODS We assessed 116 patients with severe CAV who underwent heart transplantation between 2004 and 2023. RCP was defined as symptomatic heart failure with restrictive hemodynamic values (mean right atrial pressure >12 mm Hg, pulmonary capillary wedge pressure >25 mm Hg, and cardiac index <2.0 liter/min/m2). The primary outcome was death or retransplantation. RESULTS Of the 116 patients with severe CAV, 42 had RCP (RCP-CAV group) and 74 had severe angiographic CAV without RCP (Angio-CAV group). A significantly shorter time from heart transplantation to diagnosis and lower subsequent percutaneous catheter intervention after diagnosis were seen in the RCP-CAV group than in the Angio-CAV group (both p < 0.001). Freedom from death or retransplantation at 5 years was significantly worse in the RCP-CAV group compared to the Angio-CAV group (18.4% vs 35.4%, p = 0.001). In the Cox proportional hazard model, RCP was independently associated with an increased risk of death or retransplantation (hazard ratio 2.08, 95% confidence intervals 1.26-3.44, p = 0.004). CONCLUSIONS The prognosis of patients with RCP was significantly worse than that of patients with severe angiographic CAV. The early detection of microvascular dysfunction and retransplantation listing may improve the prognosis of patients with RCP.

中文翻译：

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限制性心脏同种异体移植物生理学在严重冠状动脉同种异体移植血管病变中的结果。


背景 心脏移植术后的微血管功能障碍导致限制性心脏同种异体移植物生理学 （RCP），被归类为严重的冠状动脉同种异体移植血管病变 （CAV）;然而，RCP 的预后仍不清楚。因此，在这项研究中，我们旨在阐明 RCP 与严重血管造影 CAV 的预后。方法 我们评估了 116 年至 2004 年间接受心脏移植的 2023 例严重 CAV 患者。RCP 被定义为具有限制性血流动力学值的症状性心力衰竭 （平均右心房压 >12 mm Hg，肺毛细血管楔压 >25 mm Hg，心脏指数 <2.0 升/分钟/m2）。主要结局是死亡或再移植。结果 116 例重度 CAV 患者中，42 例为 RCP （RCP-CAV 组），74 例为无 RCP 的重度血管造影 CAV （Angio-CAV 组）。与血管 CAV 组相比，RCP-CAV 组从心脏移植到诊断的时间明显短，诊断后随后的经皮导管干预率较低 （p < 0.001）。与血管 CAV 组相比，RCP-CAV 组 5 年无死亡或再移植率显著差 （18.4% vs 35.4%，p = 0.001）。在 Cox 比例风险模型中，RCP 与死亡或再移植风险增加独立相关 （风险比 2.08,95% 置信区间 1.26-3.44，p = 0.004）。结论 RCP 患者预后显著差于重度血管造影 CAV 患者。早期发现微血管功能障碍和再移植清单可能会改善 RCP 患者的预后。