Computerized scoring of histopathology for predicting coronary vasculopathy, validated by intravascular ultrasound.
BACKGROUND
Allograft coronary vasculopathy results from a complex interplay between immunologic and non-immunologic factors. We devised a computerized biopsy scoring method based on histopathology to predict the development of coronary vasculopathy.


METHODS
One hundred forty heart transplant recipients underwent serial intravascular ultrasound analysis at baseline (within 1 month) and at 1 year after transplantation and were evaluated for development of coronary vasculopathy (change in coronary maximal intimal thickness, CMIT). We evaluated serial endomyocardial biopsy specimens for cellular rejection, vascular rejection, ischemia, and fibrosis. In a mathematical model, we computed a biopsy score in each patient based on the duration and severity of histopathology.


RESULTS
We found a significant correlation between biopsy score (RY) and progression of coronary vasculopathy (r = 0.54, p = 0.001). Using a sensitivity analysis method, an RY value of > or =560 predicted development of coronary vasculopathy with a sensitivity of 86%, specificity of 62%, and diagnostic accuracy of 80%. Compared with patients with low-risk biopsy scores (RY < 560, n = 37), patients with high-risk biopsy scores (RY > or = 560, n = 103) had increased progression of coronary vasculopathy (CMIT, 0.59 +/- 0.29 vs 0.19 +/- 0.10 mm, p < 0.001) and worse 7-year event-free survival (60% vs 91%, p = 0.01).


CONCLUSIONS
The biopsy score is an effective method for predicting the development of coronary vasculopathy and for predicting outcome in cardiac transplant recipients.
Yamani
Mohamad H
MH
Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Kaufman Center for Heart Failure, Ohio 44195, USA. yamanim@ccf.org
Tuzcu
E Murat
EM
Starling
Randall C
RC
Young
James B
JB
Cook
Daniel J
DJ
Haji
Showkat A
SA
Abdo
Ashraf
A
Crowe
Tim
T
Hobbs
Robert
R
Rincon
Gustavo
G
Bott-Silverman
Corinne
C
McCarthy
Patrick M
PM
Ratliff
Norman B
NB
D000328:Adult; D001706:Biopsy; D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000473:pathology*; D003331:Coronary Vessels / Q000000981:diagnostic imaging* / Q000473:pathology; D006084:Graft Rejection / Q000000981:diagnostic imaging / Q000473:pathology*; D016027:Heart Transplantation; D006801:Humans; D008962:Models, Theoretical; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000473:pathology*; D011237:Predictive Value of Tests; D018084:Ultrasonography, Interventional