Early Inflammatory Predictors of Cardiac Allograft Vasculopathy

Abstract

<h3>Purpose</h3> To determine whether prediction of cardiac allograft vasculopathy (CAV) in heart transplant patients improves by adding inflammatory markers to an atherothrombotic (AT) risk-prediction model. <h3>Methods and Materials</h3> AT markers (myocardial fibrin, loss of vascular antithrombin and tissue plasminogen activator, arterial endothelial intercellular adhesion molecule-1 expression) and inflammatory markers interleukin-6 (IL-6) and C-reactive protein (CRP) were measured in serial heart biopsy and serum samples of 172 patients followed prospectively for 8.9±5.0 years for CAV. First stepwise logistic regression models were estimated using only AT markers obtained from (1) the first post-transplant biopsy only (median: 9 days), or (2) all biopsies obtained within 3 months. Then model improvement was evaluated after adding IL-6 and CRP to the AT models. Final multivariate models were adjusted for other covariates and cross-validated in 200 bootstrapped samples. <h3>Results</h3> Most AT markers univariately predicted CAV at 5- and 10-years. In multivariate AT models, antithrombin and fibrin were the only significant predictors of CAV. Adding the inflammatory marker CRP, but not IL-6, to the best AT models (Table 1) improved discriminatory power as indicated by the increase in ROC value. <h3>Conclusions</h3> AT markers significantly predict future CAV. Adding the inflammatory marker CRP, but not IL-6, improves the predictive power of the AT model. [figure 1] [figure 2]