title: Multicenter intravascular ultrasound validation study among heart transplant recipients: outcomes after five years.
abstract: OBJECTIVE
  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.
authors.affiliation: University of California at Los Angeles, Los Angeles, California, USA. jonk@mednet.ucla.edu
authors.forename: Jon A
authors.initials: JA
authors.lastname: Kobashigawa
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Tobis
authors.forename: Randall C
authors.initials: RC
authors.lastname: Starling
authors.forename: E Murat
authors.initials: EM
authors.lastname: Tuzcu
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Smith
authors.forename: Hannah A
authors.initials: HA
authors.lastname: Valantine
authors.forename: Alan C
authors.initials: AC
authors.lastname: Yeung
authors.forename: Mandeep R
authors.initials: MR
authors.lastname: Mehra
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Anzai
authors.forename: Brandy T
authors.initials: BT
authors.lastname: Oeser
authors.forename: Kamal H
authors.initials: KH
authors.lastname: Abeywickrama
authors.forename: Jane
authors.initials: J
authors.lastname: Murphy
authors.forename: Nathalie
authors.initials: N
authors.lastname: Cretin
mesh_terms: D000328:Adult; D000368:Aged; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D018450:Disease Progression; D005260:Female; D016027:Heart Transplantation / Q000401:mortality*; D006801:Humans; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D013557:Switzerland / Q000453:epidemiology; D018084:Ultrasonography, Interventional; D014481:United States / Q000453:epidemiology