EXPEDITED REVIEWS
Multicenter Intravascular Ultrasound Validation Study Among Heart Transplant Recipients
Outcomes After Five Years
Jon A. Kobashigawa, MD, FACC*,*,
Jonathan M. Tobis, MD, FACC*,
Randall C. Starling, MD, MPH, FACC ,
E. Murat Tuzcu, MD, FACC,
Andrew L. Smith, MD, FACC ,
Hannah A. Valantine, MD, FACC ,
Alan C. Yeung, MD, FACC,
Mandeep R. Mehra, MD, FACC||,
Hitoshi Anzai, MD*,
Brandy T. Oeser, MPH*,
Kamal H. Abeywickrama, PhD¶,
Jane Murphy, BSN¶ and
Nathalie Cretin, MD¶
* University of California at Los Angeles, Los Angeles, California
Cleveland Clinic Foundation, Cleveland, Ohio
Emory University, Atlanta, Georgia
Stanford University, Stanford, California
|| Ochsner Clinic Foundation, New Orleans, Louisiana
¶ Novartis Pharma, Basel, Switzerland
Manuscript received August 4, 2004;
revised manuscript received January 20, 2005,
accepted February 14, 2005.
&; Reprint requests and correspondence: Dr. Jon A. Kobashigawa, Division of Cardiology, UCLA Medical Center, 100 UCLA Medical Plaza, #630, Los Angeles, California 90095. (Email: jonk{at}mednet.ucla.edu).
OBJECTIVES: We sought to assess the validity of first-year intravascular ultrasound (IVUS) data as a surrogate marker for long-term outcome after heart transplantation.
BACKGROUND: Cardiac allograft vasculopathy (CAV) is a major impediment to long-term graft survival. Intravascular ultrasound is more sensitive than coronary angiography and detects intimal thickening (early CAV) in the coronary arteries of the donor heart. Single-center studies have suggested first-year IVUS results might be a surrogate marker for long-term outcome.
METHODS: First-year IVUS results and subsequent five-year clinical follow-up data were reviewed in 125 heart transplant recipients from five institutions. The IVUS tapes (at baseline and one year) were re-analyzed at a core IVUS laboratory. The change in maximal intimal thickness (MIT) from baseline to one year was recorded for several matched sites in the same coronary artery. Patients were classified into two groups: those with  0.5 mm in the MIT in any matched site (group 1) and those with MIT <0.5 mm (group 2).
RESULTS: Group 1 patients compared with group 2 patients had a higher incidence of death or graft loss (D/GL, 20.8% vs. 5.9%; p = 0.007), had more nonfatal major adverse cardiac events and/or D/GL (45.8% vs. 16.8%; p = 0.003), and had more findings of newly occurring angiographic luminal irregularities (65.2% vs. 32.6%, p = 0.004).
CONCLUSIONS: This multicenter study suggests that progression of intimal thickening 0.5 mm in the first year after transplantation appears to be a reliable surrogate marker for subsequent mortality, nonfatal major adverse cardiac events, and development of angiographic CAV through five years after heart transplantation.
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Abbreviations and Acronyms
| | CAD = coronary artery disease | | CAV = cardiac allograft vasculopathy | | CMH = Cochran-Mantel-Haenszel | | CMV = cytomegalovirus | | D/GL = death and/or graft loss | | IA = intimal area | | IVUS = intravascular ultrasound | | MIT = maximal intimal thickness | | NF-MACE = nonfatal major adverse cardiac events |
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