title: Interplay of coronary angiography and intravascular ultrasound in predicting long-term outcomes after heart transplantation.
abstract: BACKGROUND
  Cardiac allograft vasculopathy (CAV) remains the major cause of late graft-related death after heart transplantation (HT). Identification of patients at risk of cardiovascular events has relevant implications in appropriately guiding resources and intensity of follow-up. In this context, the prognostic relevance of serial coronary imaging long-term after HT is unexplored.
  
  
  METHODS
  Recipients with intravascular ultrasound (IVUS) and coronary angiography performed 1 and 5 years after HT were monitored for subsequent 1 to 10 years to analyze the association of serial coronary imaging with cardiovascular death and major cardiovascular events (MACEs).
  
  
  RESULTS
  Included were 131 patients. The MACE incidence was 31.8 per 1,000 patient-years, and cardiovascular mortality was 17.4 per 1,000 patient-years. Progression of coronary lesions detected by angiography and changes in IVUS-defined parameters, including an increase in maximal intimal thickness (MIT) ≥0.35 mm and vascular remodeling, predicted MACE occurrence. However, only MIT change ≥0.35 mm also predicted cardiovascular mortality. Among patients with normal or stable angiography, an MIT change ≥0.35 mm identified those with a significantly higher MACE rate (80 vs 13 events/1,000 patient-years). Worsening metabolic parameters appeared associated with the increasing severity of CAV development.
  
  
  CONCLUSIONS
  Combined imaging analysis of progression of angiographic lesions and IVUS-detected MIT between 1 and 5 years post-HT allows discriminating patients at high, intermediate, and low risk for adverse long-term cardiovascular outcomes. The metabolic syndrome milieu is confirmed as a key risk factor for long-term CAV progression and adverse prognosis.
authors.affiliation: Heart Failure and Heart Transplant Program, Department of Specialist, Diagnostic, and Experimental Medicine, Alma-Mater University of Bologna, Bologna, Italy. Electronic address: luciano.potena2@unibo.it.
authors.forename: Luciano
authors.initials: L
authors.lastname: Potena
authors.affiliation: Heart Failure and Heart Transplant Program, Department of Specialist, Diagnostic, and Experimental Medicine, Alma-Mater University of Bologna, Bologna, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Masetti
authors.affiliation: Heart Failure and Heart Transplant Program, Department of Specialist, Diagnostic, and Experimental Medicine, Alma-Mater University of Bologna, Bologna, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Sabatino
authors.affiliation: Heart Failure and Heart Transplant Program, Department of Specialist, Diagnostic, and Experimental Medicine, Alma-Mater University of Bologna, Bologna, Italy.
authors.forename: Maria L
authors.initials: ML
authors.lastname: Bacchi-Reggiani
authors.affiliation: Heart Failure and Heart Transplant Program, Department of Specialist, Diagnostic, and Experimental Medicine, Alma-Mater University of Bologna, Bologna, Italy.
authors.forename: Valeria
authors.initials: V
authors.lastname: Pece
authors.affiliation: Heart Failure and Heart Transplant Program, Department of Specialist, Diagnostic, and Experimental Medicine, Alma-Mater University of Bologna, Bologna, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Prestinenzi
authors.affiliation: Heart Failure and Heart Transplant Program, Department of Specialist, Diagnostic, and Experimental Medicine, Alma-Mater University of Bologna, Bologna, Italy.
authors.forename: Gianni
authors.initials: G
authors.lastname: Dall'Ara
authors.affiliation: Heart Failure and Heart Transplant Program, Department of Specialist, Diagnostic, and Experimental Medicine, Alma-Mater University of Bologna, Bologna, Italy.
authors.forename: Nevio
authors.initials: N
authors.lastname: Taglieri
authors.affiliation: Heart Failure and Heart Transplant Program, Department of Specialist, Diagnostic, and Experimental Medicine, Alma-Mater University of Bologna, Bologna, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Saia
authors.affiliation: Heart Failure and Heart Transplant Program, Department of Specialist, Diagnostic, and Experimental Medicine, Alma-Mater University of Bologna, Bologna, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Fallani
authors.affiliation: Heart Failure and Heart Transplant Program, Department of Specialist, Diagnostic, and Experimental Medicine, Alma-Mater University of Bologna, Bologna, Italy.
authors.forename: Gaia
authors.initials: G
authors.lastname: Magnani
authors.affiliation: Heart Failure and Heart Transplant Program, Department of Specialist, Diagnostic, and Experimental Medicine, Alma-Mater University of Bologna, Bologna, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Rapezzi
authors.affiliation: Heart Failure and Heart Transplant Program, Department of Specialist, Diagnostic, and Experimental Medicine, Alma-Mater University of Bologna, Bologna, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Grigioni
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000175:diagnosis*; D017023:Coronary Angiography; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D016027:Heart Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis; D011379:Prognosis; D012307:Risk Factors; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional; D055815:Young Adult
keywords: cardiac allograft vasculopathy; coronary angiography; heart transplantation; intravascular ultrasound; long-term cardiovascular outcomes; post-heart transplant complications