title: Perioperative Risk Factors of Cardiac Allograft Vasculopathy in the Long-Term Follow-up.
abstract: BACKGROUND
  Cardiac allograft vasculopathy (CAV) still remains to be one of the most important limiting factors for heart transplant recipients' long-term survival. The aim of our study was to identify the perioperative risk factors impacting the occurrence of CAV during the long-term follow-up.
  
  
  METHODS
  We retrospectively analysed the data from 198 consecutive adult patients, who underwent heart transplantation between 2007 and 2012, in whom at least one routine coronarography (CAG) was performed. CAV onset was defined as any lesion seen at least at one routine CAG.
  
  
  RESULTS
  The average follow-up was 63.6 ± 14.7 months. The frequency of CAV in the analysed population was 36 (18.1%). Multivariate stepwise logistic regression analysis confirmed that NT-proBNP plasma concentration directly before heart transplant [logNT-proBNP OR = 16.455 (4.587-31.036), P < .0001], fibrinogen plasma concentration a month after heart transplant [OR = 1.022 (1.009-1.035), P < .001] and occurrence of diabetes [OR = 12.355 (1.417-35.750), P < .001], were independent predictors of CAV. Area under the ROC curves (AUC) indicated a well discriminatory power of plasma fibrinogen [AUC 0.9278, P < .001] and plasma NTproBNP concentration [AUC 0.9514, P < .001] in CAV prediction. The optimal cut-off value of fibrinogen was 509 mg/dL, and of NT-proBNP was 10080 pg/mL.
  
  
  CONCLUSIONS
  Our data show that NT-proBNP and fibrinogen plasma concentrations as well as occurence of diabetes, both preexisting and new onset after heart transplant can be used to identify patients at risk of developing CAV.
authors: 3(rd) Department of Cardiology, SMDZ in Zabrze, Medical University of Silesia, Katowice, Poland, Silesian Center for Heart Diseases, Zabrze, Poland. Electronic address: centrala4@wp.pl.
authors: B
authors: B
authors: Szyguła-Jurkiewicz
authors: Department of Cardiosurgery, Transplantation and Cardiovascular Surgery, SMDZ in Zabrze, Medical University of Silesia, Katowice, Poland, Silesian Center for Heart Diseases, Zabrze, Poland.
authors: M
authors: M
authors: Zakliczyński
authors: Silesian Center for Heart Diseases, Zabrze, Poland.
authors: W
authors: W
authors: Szczurek
authors: Department of Biostatistics, SPH in Bytom, Medical University of Silesia, Zabrze, Poland.
authors: M
authors: M
authors: Skrzypek
authors: 3(rd) Department of Cardiology, SMDZ in Zabrze, Medical University of Silesia, Katowice, Poland, Silesian Center for Heart Diseases, Zabrze, Poland.
authors: M
authors: M
authors: Gąsior
authors: Department of Cardiosurgery, Transplantation and Cardiovascular Surgery, SMDZ in Zabrze, Medical University of Silesia, Katowice, Poland, Silesian Center for Heart Diseases, Zabrze, Poland.
authors: M
authors: M
authors: Zembala
mesh_terms: D064591:Allografts; D003925:Diabetic Angiopathies / Q000150:complications; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000097:blood / Q000209:etiology*; D006331:Heart Diseases / Q000097:blood / Q000601:surgery*; D016027:Heart Transplantation; D006801:Humans; D006937:Hypercholesterolemia / Q000150:complications; D006973:Hypertension / Q000150:complications; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000378:metabolism; D010446:Peptide Fragments / Q000378:metabolism; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014184:Transplantation, Homologous; D016896:Treatment Outcome
chemical_list: D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain