Influence of Donor Transmitted and Rapidly Progressive Coronary Vascular Disease on Long Term Outcomes After Heart Transplantation: A Contemporary Intravascular Ultrasound Analysis.

作者：B. Sperry, R. Qarajeh, Mohamed A. Omer, H. Brandt, David M. Safley, A. Borkon, M. Everley, T. Fendler, T. Khumri, S. Lawhorn, A. Magalski, M. Nassif, D. Vodnala, A. Kao, B. Austin · 发表于：Journal of Cardiac Failure · 年份：2020 · DOI：10.1016/j.cardfail.2020.12.012 · 被引用次数：20 · 研究领域：Medicine

BACKGROUND Donor transmitted atherosclerosis (DTA) and rapidly progressive cardiac allograft vasculopathy (CAV) at 1-year are intravascular ultrasound (IVUS)-derived measures shown to predict adverse cardiovascular outcomes in the setting of early generation immunosuppressive agents. Given the paucity of data on the prognostic value of IVUS-derived measurements in the current era, we sought to explore their association with adverse outcomes after heart transplantation. METHODS This is a retrospective cohort analysis of patients who underwent heart transplantation at our center between 1/2009 and 6/2016 with baseline and 1-year IVUS. Five IVUS sections were prospectively analyzed for intimal thickness and lumen area. DTA was defined as maximum intimal thickness ≥0.5 mm at baseline, and rapidly progressive CAV as an increase in maximum intimal thickness by ≥0.5 mm at 1-year. Our primary analysis assessed the relationship of IVUS and other clinical data on a composite outcome: coronary intervention, CAV stage 2 or 3 (defined by ISHLT 2010 nomenclature), or cardiovascular death. RESULTS A total of 249 patients (mean age 51.0 +/- 12.2 years and 74.3% male) were included in the analysis. DTA was detected in 118 (51.4%) patients. Over a median follow-up of 6.1 (IQR 4.2 - 8.0) years, 45 patients met the primary endpoint (23 PCI, 11 CAV 2 or 3, and 11 cardiovascular deaths as first event). DTA and rapidly progressive CAV were not associated with the primary endpoint nor with all-c...