title: Long-term outcome after heart transplantation predicted by quantitative myocardial blush grade in coronary angiography.
abstract: The purpose of our study was to investigate whether the quantification of myocardial blush grade (MBG) during surveillance coronary angiography can predict long-term outcome after heart transplantation (HT). In 105 HT recipients who underwent cardiac catheterization, cardiac allograft vasculopathy (CAV) was assessed visually using the ISHLT grading scale (prospective cohort study). MBG was quantified by dividing the plateau of contrast agent gray-level intensity (G(max)) by the time-to-peak intensity (T(max)). In a subgroup (n = 72), myocardial perfusion index by cardiac magnetic resonance imaging (CMR) was assessed. During a mean follow-up duration of 2.7 (standard deviation [SD] 1.0) years, 26 patients experienced cardiac events, including 7 with cardiac death and 19 who underwent coronary revascularization. G(max)/T(max) was related to CAV by ISHLT criteria and to subsequent cardiac events. By univariate analysis, patient age, organ age, CAV, MBG and myocardial perfusion index by CMR were all predictive for cardiac events. Multivariable analysis demonstrated that G(max)/T(max) provided the most robust prediction of cardiac death (hazard ratio [HR] = 0.2, 95% confidence interval [CI] = 0.06-0.64, p < 0.01) and cardiac events (HR = 0.52, 95% CI = 0.32-0.84, p < 0.01), beyond clinical parameters and the presence of CAV. G(max)/T(max) is a valuable surrogate parameter of microvascular integrity, which is associated with cardiac death and revascularization procedures after HT.
authors.affiliation: Department of Cardiology, University of Heidelberg, Heidelberg, Germany. nina.hofmann@med.uni-heidelberg.de
authors.forename: N P
authors.initials: NP
authors.lastname: Hofmann
authors.forename: A
authors.initials: A
authors.lastname: Voss
authors.forename: H
authors.initials: H
authors.lastname: Dickhaus
authors.forename: M
authors.initials: M
authors.lastname: Erbacher
authors.forename: A
authors.initials: A
authors.lastname: Doesch
authors.forename: P
authors.initials: P
authors.lastname: Ehlermann
authors.forename: G
authors.initials: G
authors.lastname: Gitsioudis
authors.forename: S J
authors.initials: SJ
authors.lastname: Buss
authors.forename: E
authors.initials: E
authors.lastname: Giannitsis
authors.forename: H A
authors.initials: HA
authors.lastname: Katus
authors.forename: G
authors.initials: G
authors.lastname: Korosoglou
mesh_terms: D006328:Cardiac Catheterization; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D003326:Coronary Circulation; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006333:Heart Failure / Q000601:surgery; D016027:Heart Transplantation / Q000401:mortality / Q000592:standards*; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D009204:Myocardial Revascularization; D009206:Myocardium / Q000473:pathology*; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014184:Transplantation, Homologous