1-Year Coronary IVUS in Heart Transplant Recipient Fails to Predict 10-Year Cardiovascular Mortality

Abstract

Purpose Cardiac Allograft Vasculopathy (CAV) is one of the most frequent long-term causes of death after heart transplant (HTx). Immunological and non-immunological factors are implicated in its development. IVUS is the gold standard for CAV diagnosis. Our study evaluates the correlation between the intimal index (IntIndx=[(intimal area/vessel area)*100]) evaluated with IVUS at 1-year after HTx (as a marker of CAV), the presumed pathogenetic factors for early CAV and 10-year cardiovascular (CV) mortality. Methods From January 2008 and June 2009, 28 patients (Pts) underwent IVUS at one-year follow-up after HTx (Female 32,1%, mean age 49,3±10,6 ). According to literature, we used a 40% Intindx cut-off to identify CAV. Study sample was divided into two groups: group A (GA: IntIndx Results Overall 10-year mortality was 21.4% (6 PTs), while 10-year CV mortality was 7.1% (2 Pts, 1 Pts died for heart failure due to advanced CAV, while 1 Pts underwent re-transplant due to end-stage CAV). LAD IntIndx ≥40% was significantly associated with serum HDL at 1-month post-HTx (GA 61.6±12.7 vs GB 49.2±11.3 mg/dl; p 0.012), 1-year post-HTx serum Triglycerides (GA 134.4±29.3 vs GB 179.9±65.9 mg/dl; p 0.041), the percentage of Pts with serum ciclosporine (CyA) in therapeutic range 2 hours after ingestion (GA 91.9%±8% vs GB 78.8±18%; p 0.034), donor age (GA 38.3±12.7 vs 47.4±8.8 year; p 0.003), and donated heart ischemic time (GA 178.6±41.6 vs GB 150.7±29.1 min; p 0.046). Serum HDL at 1-, 6- and 12-months post-HTx, donor age, early positive CMV antigenemia (pp65>50 cells), were also statistically significant risk-facotrs for CAV at 1-year. Conclusion The low even-rate did not allow to compare 10-year CV mortality with IVUS findings, however, despite the small number of patients, our study shows a correlation between IVUS intimal thickness and various risk factors potentially implicated in CAV development and pathogenesi (donor age, CMV infections, non-adequate immune-suppression, and lipid profile after HTx). Further analysis on 1-year IVUS findings and non fatal CAV event are mandatory to better understand IVUS role in heart transplant recipient.