title: Ischemic cardiomyopathy is associated with coronary plaque progression and higher event rate in patients after cardiac transplantation.
abstract: BACKGROUND
  Cardiac allograft vasculopathy is the leading cause of graft failure and death in heart transplant (HTx) recipients; however, the association between the etiology of heart failure (ischemic cardiomyopathy [ICM] or non-ICM) that led to HTx and progression of cardiac allograft vasculopathy, and adverse events after HTx has not been explored.
  
  
  RESULTS
  We retrospectively included 165 HTx patients, who were followed-up with at least 2 virtual histology-intravascular ultrasound examinations after HTx, and grouped them as ICM (n=46) or non-ICM (n=119). Coronary artery plaque volume was analyzed using virtual histology-intravascular ultrasound, and cardiovascular event data-a composite of myocardial infarction, hospitalization for heart failure and arrhythmia, revascularization, retransplantation, and death including cardiovascular death-were collected from the medical records of all study subjects. ICM patients had significantly higher plaque volume at both first (P=0.040) and follow-up (P=0.015) intravascular ultrasound examinations. After multivariate adjustment for traditional coronary risk factors, ICM was significantly associated with plaque progression (odds ratio 3.10; CI 1.17 to 9.36; P=0.023). Ten-year cardiovascular event-free survival was 50% in ICM patients compared with 84% in non-ICM patients (log-rank test P=0.003). In multivariate Cox proportional hazard analysis, ICM was significantly associated with a higher event rate after HTx (hazard ratio 2.02; 95% CI 1.01 to 4.00; P=0.048).
  
  
  CONCLUSIONS
  Our study demonstrates that ischemic etiology of cardiomyopathy prior to HTx may be independently associated with plaque progression and higher event rate after HTx.
authors.affiliation: Division of Cardiovascular Diseases, Mayo College of Medicine, Rochester, MN (R.R.G., Y.M., Y.M., T.A., S.S.K., A.L.).
authors.forename: Raviteja R
authors.initials: RR
authors.lastname: Guddeti
authors.affiliation: Division of Cardiovascular Diseases, Mayo College of Medicine, Rochester, MN (R.R.G., Y.M., Y.M., T.A., S.S.K., A.L.).
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Matsuo
authors.affiliation: Division of Cardiovascular Diseases, Mayo College of Medicine, Rochester, MN (R.R.G., Y.M., Y.M., T.A., S.S.K., A.L.).
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Matsuzawa
authors.affiliation: Division of Cardiovascular Diseases, Mayo College of Medicine, Rochester, MN (R.R.G., Y.M., Y.M., T.A., S.S.K., A.L.).
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Aoki
authors.affiliation: Division of Biomedical Statistics and Informatics, Mayo College of Medicine, Rochester, MN (R.J.L.).
authors.forename: Ryan J
authors.initials: RJ
authors.lastname: Lennon
authors.affiliation: Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN (L.O.L.).
authors.forename: Lilach O
authors.initials: LO
authors.lastname: Lerman
authors.affiliation: Division of Cardiovascular Diseases, Mayo College of Medicine, Rochester, MN (R.R.G., Y.M., Y.M., T.A., S.S.K., A.L.).
authors.forename: Sudhir S
authors.initials: SS
authors.lastname: Kushwaha
authors.affiliation: Division of Cardiovascular Diseases, Mayo College of Medicine, Rochester, MN (R.R.G., Y.M., Y.M., T.A., S.S.K., A.L.).
authors.forename: Amir
authors.initials: A
authors.lastname: Lerman
mesh_terms: D000328:Adult; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000453:epidemiology; D009202:Cardiomyopathies / Q000209:etiology / Q000601:surgery*; D016022:Case-Control Studies; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000453:epidemiology*; D018450:Disease Progression; D005260:Female; D006333:Heart Failure / Q000453:epidemiology; D016027:Heart Transplantation; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D017202:Myocardial Ischemia / Q000150:complications*; D009204:Myocardial Revascularization / Q000706:statistics & numerical data; D058226:Plaque, Atherosclerotic / Q000000981:diagnostic imaging / Q000453:epidemiology*; D016016:Proportional Hazards Models; D012086:Reoperation; D012189:Retrospective Studies; D018084:Ultrasonography, Interventional
keywords: cardiac allograft vasculopathy; ischemic cardiomyopathy; nonischemic cardiomyopathy; plaque progression; virtual histology–intravascular ultrasound
references.citation: Circulation. 1998 May 12;97(18):1837-47
references.pmid: 9603539
references.citation: J Am Coll Cardiol. 2002 Jan 16;39(2):210-8
references.pmid: 11788209
references.citation: J Am Coll Cardiol. 1996 Mar 15;27(4):839-46
references.pmid: 8613612
references.citation: Am J Cardiol. 2008 Jun 16;101(12A):51F-57F
references.pmid: 18549872
references.citation: Circ Res. 2006 Oct 13;99(8):801-15
references.pmid: 17038650
references.citation: J Am Coll Cardiol. 2009 Apr 14;53(15):1279-86
references.pmid: 19358941
references.citation: J Heart Lung Transplant. 2007 Aug;26(8):826-33
references.pmid: 17692787
references.citation: Circulation. 2000 Nov 7;102(19 Suppl 3):III233-6
references.pmid: 11082393
references.citation: Circulation. 1997 Nov 4;96(9):3248-50
references.pmid: 9386201
references.citation: Eur Heart J. 2013 Sep;34(33):2610-7
references.pmid: 23801824
references.citation: J Heart Lung Transplant. 2007 Aug;26(8):769-81
references.pmid: 17692781
references.citation: Am J Prev Med. 2002 Jul;23(1):51-61
references.pmid: 12093424
references.citation: Cardiovasc Res. 2002 Feb 15;53(3):538-49
references.pmid: 11861024
references.citation: Lancet. 2010 May 1;375(9725):1536-44
references.pmid: 20435228
references.citation: J Heart Lung Transplant. 2005 Nov;24(11):1710-20
references.pmid: 16297770
references.citation: EuroIntervention. 2009 Jun;5(2):177-89
references.pmid: 20449928
references.citation: J Heart Lung Transplant. 2010 Jul;29(7):717-27
references.pmid: 20620917
references.citation: J Heart Lung Transplant. 2011 Oct;30(10):1078-94
references.pmid: 21962016
references.citation: Circulation. 1995 Dec 15;92(12):3445-52
references.pmid: 8521566
references.citation: Eur Heart J. 2013 Oct;34(37):2905-15
references.pmid: 23782648
references.citation: J Heart Lung Transplant. 2010 Aug;29(8):914-56
references.pmid: 20643330
references.citation: Transplant Proc. 1995 Jun;27(3):1975-6
references.pmid: 7792856
references.citation: Circulation. 1997 Sep 16;96(6):2069-77
references.pmid: 9323100
references.citation: J Heart Lung Transplant. 2000 Feb;19(2):167-72
references.pmid: 10703693
references.citation: Am Heart J. 1990 Oct;120(4):963-9
references.pmid: 2220549
references.citation: Ann Intern Med. 1999 Mar 16;130(6):461-70
references.pmid: 10075613
references.citation: Circulation. 2007 Dec 4;116(23):2726-33
references.pmid: 18025531
references.citation: Circulation. 2001 Feb 20;103(7):934-40
references.pmid: 11181466
references.citation: Transplantation. 2008 Apr 15;85(7):963-8
references.pmid: 18408575
references.citation: Circulation. 2012 Feb 7;125(5):708-20
references.pmid: 22207715
references.citation: Eur Heart J. 2009 Jun;30(11):1356-63
references.pmid: 19383734
references.citation: Can J Cardiol. 2003 Sep;19(10):1147-53
references.pmid: 14532940
references.citation: Circulation. 1999 Aug 31;100(9):988-98
references.pmid: 10468531
references.citation: Circulation. 2008 Apr 22;117(16):2131-41
references.pmid: 18427143
references.citation: Am J Cardiol. 2007 Sep 15;100(6):953-9
references.pmid: 17826376
references.citation: J Am Coll Cardiol. 2003 Aug 6;42(3):477-82
references.pmid: 12906976
references.citation: J Heart Lung Transplant. 2003 Jul;22(7):711-4
references.pmid: 12873537
references.citation: Circulation. 2003 Jan 28;107(3):499-511
references.pmid: 12551878
references.citation: Transplantation. 2006 Oct 27;82(8):1108-11
references.pmid: 17060862
references.citation: Circulation. 1998 May 12;97(18):1876-87
references.pmid: 9603549
references.citation: J Am Coll Cardiol. 2006 Jun 20;47(12):2405-12
references.pmid: 16781367