Influence of cytomegalovirus infection in the development of cardiac allograft vasculopathy after heart transplantation.
BACKGROUND
Cardiac allograft vasculopathy (CAV) is a major cause of long-term morbidity and mortality after heart transplantation (HTx), whose relationship with CMV infection is uncertain. This study evaluated the influence of CMV infection in the development of CAV.


METHODS
We enrolled 166 consecutive HTx recipients who underwent their first transplant from January 1995 to July 2002. All patients received 14 days of intravenous ganciclovir and were prospectively monitored for CMV infection during the first year after HTx. CAV was diagnosed by coronary angiography performed at 1, 5, and 10 years after HTx, following the new criteria of the International Society for Heart and Lung Transplantation. We collected all variables potentially related with the development of CAV. Risk factors were studied using a complementary log-log model.


RESULTS
After a median follow-up of 11 years (range, 1-17 years), 72 patients (43%) developed CAV (63.8% CAV(1), 15.2% CAV(2), 20.8% CAV(3)). Symptoms secondary to CAV were present in 32% of these patients, and 8% died because of it. In the regression multivariate analysis, independent variables associated with the development of CAV were donor age (hazard ratio [HR], 1.028; 95% confidence interval [CI], 1.002-1.053; p < 0.028), presence of cellular acute rejection ≥ 2R (HR, 1.764; 95% CI, 1.011-3.078; p < 0.0414), CMV infection (HR, 2.334; 95% CI, 1.043-5.225; p < 0.0354), and not having been treated with a calcium channel blocker (HR, 0.472; 95% CI, 0.275-0.811; p < 0.0055).


CONCLUSIONS
Standardized angiographic criteria show CMV infection is associated with the development of CAV.
Cardiology Department. Electronic address: juan.delgado@salud.madrid.org.
Juan F
JF
Delgado
Infectious Disease Unit.
Ana García
AG
Reyne
Cardiology Department.
Santiago
S
de Dios
Infectious Disease Unit.
Francisco
F
López-Medrano
Cardiology Department.
Alfonso
A
Jurado
Infectious Disease Unit.
Rafael San
RS
Juan
Cardiology Department.
María José
MJ
Ruiz-Cano
Microbiology Department, University Hospital 12 de Octubre, Instituto de Investigación Hospital 12 de Octubre, Madrid, Spain.
M
M
Dolores Folgueira
Cardiology Department.
Miguel Ángel
MÁ
Gómez-Sánchez
Infectious Disease Unit.
José María
JM
Aguado
Infectious Disease Unit.
Carlos
C
Lumbreras
D000328:Adult; D000368:Aged; D003586:Cytomegalovirus Infections / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D018572:Disease-Free Survival; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology / Q000821:virology*; D006333:Heart Failure / Q000401:mortality / Q000601:surgery* / Q000821:virology*; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors
calcium channel blocker; cardiac allograft vasculopathy; cardiac angiography; cytomegalovirus infection; heart transplantation