title: Paradoxical Vessel Remodeling of the Proximal Segment of the Left Anterior Descending Artery Predicts Long-Term Mortality After Heart Transplantation.
abstract: OBJECTIVE
  This study investigated the association between arterial remodeling and geographic distribution of cardiac allograft vasculopathy (CAV), and outcomes after heart transplantation.
  
  
  BACKGROUND
  CAV is characterized by a combination of coronary intimal thickening and pathological vessel remodeling, which varies at different locations in coronary arteries.
  
  
  METHODS
  In 100 transplant recipients, serial volumetric intravascular ultrasonography (IVUS) was performed at baseline and 1 year post-transplantation in the first 50 mm of the left anterior descending artery (LAD). IVUS indices were evaluated in the entire segment and 3 equally divided LAD segments. Paradoxical vessel remodeling was defined as [Δvessel volume/Δintimal volume <0].
  
  
  RESULTS
  After 1 year, death or re-transplantation occurred in 20 patients over a median follow-up period of 4.7 years. Paradoxical vessel remodeling was observed in 57%, 41%, 50%, and 40% for the entire vessel, proximal, middle, and distal LAD segments, respectively. Kaplan-Meier analysis revealed a significantly lower event-free rate of survival in patients with paradoxical vessel remodeling involving the proximal LAD segment, which was not present when involving the entire LAD or mid and distal LAD segments. In multivariate analysis, paradoxical vessel remodeling of the proximal LAD segment was independently associated with death or re-transplantation (hazard ratio [HR]: 11.18; 95% confidence interval [CI]: 2.39 to 83.23; p = 0.0015).
  
  
  CONCLUSIONS
  Despite the diffuse nature of CAV, paradoxical vessel remodeling of the proximal LAD segment at 1 year was the primary determinant of long-term mortality or re-transplantation. Assessment of arterial remodeling combined with coronary intimal thickening may enhance identification of high-risk patients who may benefit from closer follow-up and targeted medical therapies.
authors.affiliation: Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University Medical Center, Palo Alto, California.
authors.forename: Kozo
authors.initials: K
authors.lastname: Okada
authors.affiliation: Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University Medical Center, Palo Alto, California.
authors.forename: Hideki
authors.initials: H
authors.lastname: Kitahara
authors.affiliation: Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University Medical Center, Palo Alto, California.
authors.forename: Hyoung-Mo
authors.initials: HM
authors.lastname: Yang
authors.affiliation: Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University Medical Center, Palo Alto, California.
authors.forename: Shigemitsu
authors.initials: S
authors.lastname: Tanaka
authors.affiliation: Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University Medical Center, Palo Alto, California.
authors.forename: Yuhei
authors.initials: Y
authors.lastname: Kobayashi
authors.affiliation: Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University Medical Center, Palo Alto, California.
authors.forename: Takumi
authors.initials: T
authors.lastname: Kimura
authors.affiliation: Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University Medical Center, Palo Alto, California.
authors.forename: Helen
authors.initials: H
authors.lastname: Luikart
authors.affiliation: Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University Medical Center, Palo Alto, California.
authors.forename: Paul G
authors.initials: PG
authors.lastname: Yock
authors.affiliation: Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University Medical Center, Palo Alto, California.
authors.forename: Alan C
authors.initials: AC
authors.lastname: Yeung
authors.affiliation: Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University Medical Center, Palo Alto, California.
authors.forename: Hannah A
authors.initials: HA
authors.lastname: Valantine
authors.affiliation: Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University Medical Center, Palo Alto, California.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Fitzgerald
authors.affiliation: Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University Medical Center, Palo Alto, California.
authors.forename: Kiran K
authors.initials: KK
authors.lastname: Khush
authors.affiliation: Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University Medical Center, Palo Alto, California.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Honda
authors.affiliation: Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University Medical Center, Palo Alto, California. Electronic address: wfearon@stanford.edu.
authors.forename: William F
authors.initials: WF
authors.lastname: Fearon
mesh_terms: D000328:Adult; D002140:California / Q000453:epidemiology; D017023:Coronary Angiography; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000503:physiopathology*; D051799:Delayed Graft Function / Q000401:mortality* / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000401:mortality / Q000601:surgery*; D016027:Heart Transplantation / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D018084:Ultrasonography, Interventional; D066253:Vascular Remodeling / Q000502:physiology*
keywords: cardiac transplant; intravascular ultrasonography; long-term mortality; pathological remodeling; vasculopathy