Prognostic Significance of Myocardial Blood Flow Reserve and Stress Myocardial Blood Flow in the Assessment…

Cohort studyThe Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation· Aug 2026

Prognostic Significance of Myocardial Blood Flow Reserve and Stress Myocardial Blood Flow in the Assessment of Cardiac Allograft Vasculopathy in Heart Transplant Recipients.

Liam J Stanton, Nikil Prasad, Andrew J Einstein … Kevin J Clerkin

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Cardiovascular ImagingCohort studyPrognosisQ1IF 5.5

Reduced blood flow reserve and stress flow linked to tripled death or retransplant risk

Prognostic Significance of Myocardial Blood Flow Reserve and Stress Myocardial Blood Flow in the Assessment of Cardiac Allograft Vasculopathy in Heart Transplant Recipients.

Liam J Stanton … Kevin J Clerkin

The Journal of heart and lung transplantation · Aug 2026 · Q1 in Respiratory Medicine

Background

Cardiac allograft vasculopathy limits longevity following heart transplantation (heart transplantation).

Purpose

We sought to assess the relative prognostic relevance of stress myocardial blood flow (sMBF) and myocardial blood flow reserve (myocardial blood flow reserve) on post-transplant outcomes.

Methods

Were categorized by myocardial blood flow reserve (normal myocardial blood flow reserve >2.0, low myocardial blood flow reserve ≤2.0) and sMBF (normal sMBF >1.7 mL/min/g, low sMBF ≤1.7 mL/min/g) values into three groups: concordant normal, discordant, or concordant low.

n = 454 patients

Results

double drop in flow raises death or retransplant risk more than 3-fold

HR by subgroup · 95% CI

More results

Among 454 patients (25.8% female, median age 59 years, median time since heart transplantation 7.2 years), 287 (63.2%) had concordant normal myocardial blood flow reserve and sMBF, 72 (15.9%) had discordant values (37 myocardial blood flow reserve low, 35 sMBF low), and 95 (20.9%) were concordant low.

More results

The risk remained elevated for those with discordant values, though magnitude of risk was lower (HR 2.5, 95% CI 1.6-3.9, p=0.0001).

Rate pressure product correction did not impact results.

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Conclusion

In this cohort, reduction in both sMBF and myocardial blood flow reserve was associated with the highest risk of death or retransplant during a median follow-up of 7 years.

Prognostic Significance of Myocardial Blood Flow Reserve and Stress Myocardial Blood Flow in the Assessment of Cardiac Allograft Vasculopathy in Heart Transplant Recipients.

Prognostic Significance of Myocardial Blood Flow Reserve and Stress Myocardial Blood Flow in the Assessment of Cardiac Allograft Vasculopathy in Heart Transplant Recipients.

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