Multicenter intravascular ultrasound validation study among heart transplant recipients: outcomes after five years.
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.
Kobashigawa
Jon A
JA
University of California at Los Angeles, Los Angeles, California, USA. jonk@mednet.ucla.edu
Tobis
Jonathan M
JM
Starling
Randall C
RC
Tuzcu
E Murat
EM
Smith
Andrew L
AL
Valantine
Hannah A
HA
Yeung
Alan C
AC
Mehra
Mandeep R
MR
Anzai
Hitoshi
H
Oeser
Brandy T
BT
Abeywickrama
Kamal H
KH
Murphy
Jane
J
Cretin
Nathalie
N
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