title: Cardiogenic shock and coronary endothelial dysfunction predict cardiac allograft vasculopathy after heart transplantation.
abstract: Cardiac allograft vasculopathy remains one of the major causes of death post-heart transplantation. Its etiology is multifactorial and prevention is challenging. The aim of this study was to prospectively determine factors related to cardiac allograft vasculopathy after heart transplantation. This research was planned on 179 patients submitted to heart transplant. Performance of an early coronary angiography with endothelial function evaluation was scheduled at three-month post-transplant. Patients underwent a second coronary angiography after five-yr follow-up. At the 5- ± 2-yr follow-up, 43% of the patients had developed cardiac allograft vasculopathy (severe in 26% of them). Three independent predictors of cardiac allograft vasculopathy were identified: cardiogenic shock at the time of the transplant operation (OR: 6.49; 95% CI: 1.86-22.7, p = 0.003); early coronary endothelial dysfunction (OR: 3.9; 95% CI: 1.49-10.2, p = 0.006), and older donor age (OR: 1.05; 95% CI: 1.00-1.10, p = 0.044). Besides early endothelial coronary dysfunction and older donor age, a new predictor for development of cardiac allograft vasculopathy was identified: cardiogenic shock at the time of transplantation. In these high-risk patient subgroups, preventive measures (treatment of cardiovascular risk factors, use of novel immunosuppressive agents such as mTOR inhibitors) should be earlier and much more aggressive.
authors.affiliation: Àrea de Malalties del Cor, Bellvitge University Hospital, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; Department of Cardiology, Virgen de las Nieves University Hospital, FIBAO, Granada, Spain.
authors.forename: Silvia
authors.initials: S
authors.lastname: Lopez-Fernandez
authors.forename: Nicolas
authors.initials: N
authors.lastname: Manito-Lorite
authors.forename: Joan Antoni
authors.initials: JA
authors.lastname: Gómez-Hospital
authors.forename: Josep
authors.initials: J
authors.lastname: Roca
authors.forename: Carles
authors.initials: C
authors.lastname: Fontanillas
authors.forename: Rafael
authors.initials: R
authors.lastname: Melgares-Moreno
authors.forename: José
authors.initials: J
authors.lastname: Azpitarte-Almagro
authors.forename: Angel
authors.initials: A
authors.lastname: Cequier-Fillat
mesh_terms: D000328:Adult; D064591:Allografts; D017023:Coronary Angiography; D003327:Coronary Disease / Q000175:diagnosis* / Q000401:mortality; D003331:Coronary Vessels / Q000473:pathology*; D004730:Endothelium, Vascular / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality; D006085:Graft Survival; D016027:Heart Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D012770:Shock, Cardiogenic / Q000503:physiopathology*; D015996:Survival Rate
keywords: cardiac allograft vasculopathy; cardiogenic shock; cardiovascular risk factors; endothelial coronary dysfunction; heart transplantation; transplant