Abstract 11146: Coronary Artery Negative Remodeling and Intimal Thickening Predict Long-Term Clinical Outcomes After Heart Transplantation
Introduction: Heart transplant studies have primarily focused on coronary artery intimal thickening to assess severity of cardiac allograft vasculopathy. More recently, negative vessel remodeling has been recognized as another important measure. This study aimed to investigate the association between early vessel remodeling and clinical prognosis after heart transplantation.
Methods: In 99 recipients of heart transplants, baseline (4-6 weeks post-transplant) and 1-year volumetric intravascular ultrasound (IVUS) was performed in the first 50 mm of the left anterior descending coronary artery. In categorical analysis, significant intimal thickening and vessel remodeling were defined using the median value of the volume change. Acute cellular rejection was determined by endomyocardial biopsy as ISHLT Grade ≥2R. Clinical outcomes were followed for a median of 5.2 years, and late major adverse events were defined as death or re-transplantation after the first year.
Results: During the first year after transplant, 30.4% of patients experienced one or more episodes of acute cellular rejection. Patients with acute rejection showed significantly greater intimal thickening (Δintimal volume), whereas vessel remodeling (Δvessel volume) did not differ between patients with or without acute rejection. After 1 year, adverse events occurred in 28.5% of patients, and were significantly associated with vessel shrinkage during the first year. Kaplan-Meier analysis demonstrated the lowest long-term event-free survival in patients with both vessel shrinkage and intimal thickening detected at 1-year post-transplant.
Conclusions: In this population, negative vessel remodeling was the primary determinant of long-term mortality or re-transplantation. Combined assessment of both vessel remodeling and intimal thickening enhances the prognostic value of IVUS by identifying high-risk patients who may benefit from close follow-up and targeted medical therapies.
Author Disclosures: K. Okada: None. H. Kitahara: None. H. Yang: None. H. Lim: None. K. Otagiri: None. S. Tanaka: None. Y. Kobayashi: None. P. Yock: None. A. Yeung: None. P. Fitzgerald: None. K. Khush: None. Y. Honda: None. W. Fearon: None.
- © 2014 by American Heart Association, Inc.