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Aspirin therapy after heart transplantation is associated with higher myocardial perfusion reserve assessed by cardiovascular magnetic resonance imaging

Jablonowski, R. LU ; Löfman, I. H. ; Andersson, H. B. LU ; Gjesdal, G. LU ; Fogarasi, C. ; Kellman, P. LU ; Melin, M. ; Engblom, H. LU ; Arheden, H. LU and Carlsson, M. , et al. (2026) In JHLT Open 13.
Abstract

Background: Cardiac allograft vasculopathy (CAV) is one of the major long-term complications in patients after heart transplantation (HTx) limiting allograft function and longevity. CAV can be studied non-invasively by evaluating myocardial perfusion (MP). Aspirin is re--ed after Htx, but it is unclear whether it affects the development of CAV. The aim of this study was to investigate the association between aspirin therapy and MP, as a marker of CAV, using cardiovascular magnetic resonance (CMR). Methods: We consecutively included HTx patients from 2 centers in Sweden who were examined with CMR and coronary angiography. Patients were categorized by the presence or absence of aspirin therapy. As a part of routine surveillance,... (More)

Background: Cardiac allograft vasculopathy (CAV) is one of the major long-term complications in patients after heart transplantation (HTx) limiting allograft function and longevity. CAV can be studied non-invasively by evaluating myocardial perfusion (MP). Aspirin is re--ed after Htx, but it is unclear whether it affects the development of CAV. The aim of this study was to investigate the association between aspirin therapy and MP, as a marker of CAV, using cardiovascular magnetic resonance (CMR). Methods: We consecutively included HTx patients from 2 centers in Sweden who were examined with CMR and coronary angiography. Patients were categorized by the presence or absence of aspirin therapy. As a part of routine surveillance, quantitative short-axis perfusion maps were acquired at rest and during stress hyperemia. A global average MP was calculated at rest and stress and myocardial perfusion reserve (MPR) was defined as the ratio between stress and rest MP. Cine images and T1 maps were also acquired. Results: A total of 137 patients (n = 107 aspirin) were included in the study. Resting myocardial perfusion was lower in HTx recipients receiving aspirin therapy compared with those not receiving aspirin (1.0 ± 0.3 vs 1.2 ± 0.4 ml/min/g; p = 0.003); stress myocardial perfusion was higher in patients treated with aspirin (2.6 ± 0.8 vs 2.2 ± 1.0 ml/min/g; p = 0.037). Consequently, myocardial perfusion reserve (MPR) was significantly greater in patients receiving aspirin compared with those not on aspirin therapy (2.5 ± 0.7 vs 1.9 ± 0.8; p < 0.001). In both univariable and multivariable linear regression analyses, aspirin therapy remained independently associated with higher MPR after adjustment for sex, CAV grade, time from transplantation to CMR, diabetes, statin therapy, and everolimus use. Conclusion: In this retrospective study, aspirin therapy in heart transplant patients was independently associated with higher myocardial perfusion reserve.

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Contribution to journal
publication status
published
subject
keywords
Aspirin, Cardiac allograft vasculopathy, Cardiovascular magnetic resonance, Heart transplant, Myocardial perfusion
in
JHLT Open
volume
13
article number
100592
publisher
Elsevier
external identifiers
  • pmid:42256244
  • scopus:105040540340
ISSN
2950-1334
DOI
10.1016/j.jhlto.2026.100592
language
English
LU publication?
yes
id
2da6e765-5d4e-4467-a9e5-4e2f21935055
date added to LUP
2026-07-03 11:20:48
date last changed
2026-07-04 03:00:08
@article{2da6e765-5d4e-4467-a9e5-4e2f21935055,
  abstract     = {{<p>Background: Cardiac allograft vasculopathy (CAV) is one of the major long-term complications in patients after heart transplantation (HTx) limiting allograft function and longevity. CAV can be studied non-invasively by evaluating myocardial perfusion (MP). Aspirin is re--ed after Htx, but it is unclear whether it affects the development of CAV. The aim of this study was to investigate the association between aspirin therapy and MP, as a marker of CAV, using cardiovascular magnetic resonance (CMR). Methods: We consecutively included HTx patients from 2 centers in Sweden who were examined with CMR and coronary angiography. Patients were categorized by the presence or absence of aspirin therapy. As a part of routine surveillance, quantitative short-axis perfusion maps were acquired at rest and during stress hyperemia. A global average MP was calculated at rest and stress and myocardial perfusion reserve (MPR) was defined as the ratio between stress and rest MP. Cine images and T1 maps were also acquired. Results: A total of 137 patients (n = 107 aspirin) were included in the study. Resting myocardial perfusion was lower in HTx recipients receiving aspirin therapy compared with those not receiving aspirin (1.0 ± 0.3 vs 1.2 ± 0.4 ml/min/g; p = 0.003); stress myocardial perfusion was higher in patients treated with aspirin (2.6 ± 0.8 vs 2.2 ± 1.0 ml/min/g; p = 0.037). Consequently, myocardial perfusion reserve (MPR) was significantly greater in patients receiving aspirin compared with those not on aspirin therapy (2.5 ± 0.7 vs 1.9 ± 0.8; p &lt; 0.001). In both univariable and multivariable linear regression analyses, aspirin therapy remained independently associated with higher MPR after adjustment for sex, CAV grade, time from transplantation to CMR, diabetes, statin therapy, and everolimus use. Conclusion: In this retrospective study, aspirin therapy in heart transplant patients was independently associated with higher myocardial perfusion reserve.</p>}},
  author       = {{Jablonowski, R. and Löfman, I. H. and Andersson, H. B. and Gjesdal, G. and Fogarasi, C. and Kellman, P. and Melin, M. and Engblom, H. and Arheden, H. and Carlsson, M. and Nickander, J. and Braun, O.}},
  issn         = {{2950-1334}},
  keywords     = {{Aspirin; Cardiac allograft vasculopathy; Cardiovascular magnetic resonance; Heart transplant; Myocardial perfusion}},
  language     = {{eng}},
  publisher    = {{Elsevier}},
  series       = {{JHLT Open}},
  title        = {{Aspirin therapy after heart transplantation is associated with higher myocardial perfusion reserve assessed by cardiovascular magnetic resonance imaging}},
  url          = {{http://dx.doi.org/10.1016/j.jhlto.2026.100592}},
  doi          = {{10.1016/j.jhlto.2026.100592}},
  volume       = {{13}},
  year         = {{2026}},
}