Impaired left ventricular systolic function early after heart transplantation is associated with cardiac allograft vasculopathy.
Cardiac allograft vasculopathy (CAV) is a major cause of death more than 1 year after heart transplantation. We evaluated the role and possible predictive value of different etiological factors on development of CAV as diagnosed by quantitative coronary angiography (QCA). A total of 121 patients were studied with baseline QCA and 117 had a follow-up study at 1 year to assess the relationship of mean lumen diameter loss (MLDL) in main coronary arteries to immunological and non-immunological factors potentially affecting long-term survival. Out of them, 103 patients were males (85%), 114 (94%) patients were Caucasians and mean age was 48.5 +/- 10 years. Univariate analysis showed that MLDL at 1 year was inversely related to echocardiographic fractional shortening (FS) measured within the first week after transplantation (p = 0.0098) and to intracranial hemorrhage as cause of donor death (p = 0.04) and was directly related to male donors (p = 0.0008), domino transplants (p = 0.037) and donor negative cytomegalovirus (CMV) status (p = 0.022). Multivariate analysis showed that initial FS (p = 0.006) and donor intracranial hemorrhage as a cause of death (p = 0.042) were inversely related to MLDL whereas donor male sex (p = 0.003) and prednisolone treatment throughout the first year (p = 0.012) were directly related. Thus, left ventricular systolic dysfunction early after heart transplantation was associated with subsequent development of CAV.
Bolad
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IA
Transplant Unit, Harefield Hospital, Royal Brompton and Harefield NHS Trust, Hill End Road, Harefield, Middlesex UB9 6JH, UK.
Robinson
D R
DR
Webb
C
C
Hamour
I
I
Burke
M M
MM
Banner
N R
NR
D017023:Coronary Angiography / Q000379:methods; D003327:Coronary Disease / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000209:etiology*; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000473:pathology; D004452:Echocardiography; D005260:Female; D016027:Heart Transplantation / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D013599:Systole; D014184:Transplantation, Homologous; D018487:Ventricular Dysfunction, Left / Q000150:complications* / Q000175:diagnosis / Q000209:etiology