Abstract 2413: C-reactive protein, Vascular Cell Adhesion Molecule and Neopterin are Markers of Advanced Cardiac Allograft Vasculopathy Determined by Intravascular Ultrasound
A range of inflammatory mediators are likely to be responsible for the development of cardiac allograft vasculopathy (CAV), but a broad characterization of these markers in relation to different intravascular ultrasound (IVUS) endpoints has not been performed previously. Consquently, we evaluated an extensive profile of clinical variables and immune markers to assess the chronic inflammatory milieu associated with advanced CAV assessed by IVUS.
Methods: In total, 101 heart transplant (HTx) recipients were included and all patients underwent IVUS examination and plasma sampling for measurement of the following immune markers: C-reactive protein (CRP), soluble tumor necrosis factor receptor-1 (sTNFR-1), interleukin-6 (IL-6), osteoprotegerin (OPG), soluble gp130, von Willebrand factor (vWf), vascular cell adhesion molecule-1 (VCAM-1) and neopterin.
Results: Mean Percent Atheroma Volume (PAV) was 32.4 ± 9.5%. Levels of CRP, sTNFR-1, VCAM-1 and neopterin were significantly higher (p < 0.05) amongst patients with PAV < 32% (n = 50). Similar significant results were found when using Maximal Intimal Thickness (MIT) > 0.5 mm (n = 47) as an alternative IVUS endpoint. Multivariate regression analysis revealed that CRP > 1.5 mg/L [adjusted OR 4.5 (95% CI 1.7–12.4), p < 0.01], VCAM-1 > 391 ng/mL [adjusted OR 3.2 (95% CI 1.1–9.7), p = 0.04] and neopterin > 767 nmol/L [adjusted OR 3.8 (95% CI (1.2–11.7), p = 0.02] were independently associated with PAV > 32%.
Conclusion: Advanced CAV quantified by IVUS is associated with an inflammatory signature comprising of elevated CRP, VCAM-1 and neopterin and reflects the multi-faceted immunological activity contributing to CAV development. Forthcoming studies should clarify if measurements of these markers will allow more individualized CAV surveillance and management of HTx recipients.