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Multicenter intravascular ultrasound validation study among heart transplant recipients: outcomes after five years.

Abstract：

OBJECTIVES:We sought to assess the validity of first-year intravascular ultrasound (IVUS) data as a surrogate marker for long-term outcome after heart transplantation. BACKGROUND:Cardiac allograft vasculopathy (CAV) is a major impediment to long-term graft survival. Intravascular ultrasound is more sensitive than coronary angiography and detects intimal thickening (early CAV) in the coronary arteries of the donor heart. Single-center studies have suggested first-year IVUS results might be a surrogate marker for long-term outcome. METHODS:First-year IVUS results and subsequent five-year clinical follow-up data were reviewed in 125 heart transplant recipients from five institutions. The IVUS tapes (at baseline and one year) were re-analyzed at a core IVUS laboratory. The change in maximal intimal thickness (MIT) from baseline to one year was recorded for several matched sites in the same coronary artery. Patients were classified into two groups: those with >/=0.5 mm in the MIT in any matched site (group 1) and those with MIT <0.5 mm (group 2). RESULTS:Group 1 patients compared with group 2 patients had a higher incidence of death or graft loss (D/GL, 20.8% vs. 5.9%; p = 0.007), had more nonfatal major adverse cardiac events and/or D/GL (45.8% vs. 16.8%; p = 0.003), and had more findings of newly occurring angiographic luminal irregularities (65.2% vs. 32.6%, p = 0.004). CONCLUSIONS:This multicenter study suggests that progression of intimal thickening >/=0.5 mm in the first year after transplantation appears to be a reliable surrogate marker for subsequent mortality, nonfatal major adverse cardiac events, and development of angiographic CAV through five years after heart transplantation.

journal_name

J Am Coll Cardiol

journal_title

Journal of the American College of Cardiology

authors

Kobashigawa JA,Tobis JM,Starling RC,Tuzcu EM,Smith AL,Valantine HA,Yeung AC,Mehra MR,Anzai H,Oeser BT,Abeywickrama KH,Murphy J,Cretin N

doi

10.1016/j.jacc.2005.02.035

subject

Has Abstract

pub_date

2005-05-03 00:00:00

pages

1532-7

issue

eissn

0735-1097

issn

1558-3597

pii

S0735-1097(05)00465-1

journal_volume

pub_type

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Multicenter intravascular ultrasound validation study among heart transplant recipients: outcomes after five years.