Influence of Donor Transmitted and Rapidly Progressive Coronary Vascular Disease on Long-Term Outcomes After Heart Transplantation: A Contemporary Intravascular Ultrasound Analysis

Sperry, Brett W.; Qarajeh, Raed; Omer, Mohamed; Brandt, Hunter; Safley, David M.; Borkon, A. Michael; Everley, M.P.; Fendler, Timothy J.; Khumri, Taiyeb M.; Lawhorn, S.L.; Magalski, Anthony; Nassif, Michael E.; Vodnala, Deepthi; Kao, Andrew; Austin, Bethany A.

doi:10.1016/j.cardfail.2020.12.012

Cited by 16 publications

(10 citation statements)

References 21 publications

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“…This high prevalence of DTA is consistent with other contemporary cohorts. 13,14,20 The impact of preexisting DTA on CAV development and long-term clinical outcomes is unclear. Apparent differing findings on DTA and CAV development may, in part, be related to variable study definitions for DTA, patient comparison groups (ie, DTA versus no DTA or versus de novo CAV), and measures for coronary disease progression.…”

Section: Donor Atherosclerosis and Cav Progressionmentioning

confidence: 99%

“…13,14,[20][21][22] Notably, change in MIT is often used to assess CAV progression, which may not be an ideally sensitive approach as it does not consider vessel remodeling or changes along the entire vessel in the case of matched segment analysis at fixed vessel sites. 20,21 Related is the commonly used surrogate end point of MIT ≥0.5 mm increase at 1 year posttransplant defining rapidly progressive CAV, shown to predict adverse cardiovascular outcomes. 4 Importantly, the prognostic utility of this specific measure has not been established in the current era.…”

Section: Donor Atherosclerosis and Cav Progressionmentioning

confidence: 99%

“…Apparent differing findings on DTA and CAV development may, in part, be related to variable study definitions for DTA, patient comparison groups (ie, DTA versus no DTA or versus de novo CAV), and measures for coronary disease progression. 13,14,[20][21][22] Notably, change in MIT is often used to assess CAV progression, which may not be an ideally sensitive approach as it does not consider vessel remodeling or changes along the entire vessel in the case of matched segment analysis at fixed vessel sites. 20,21 Related is the commonly used surrogate end point of MIT ≥0.5 mm increase at 1 year posttransplant defining rapidly progressive CAV, shown to predict adverse cardiovascular outcomes.…”

Section: Donor Atherosclerosis and Cav Progressionmentioning

confidence: 99%

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Fibrotic Plaque and Microvascular Dysfunction Predict Early Cardiac Allograft Vasculopathy Progression After Heart Transplantation: The Early Post Transplant Cardiac Allograft Vasculopathy Study

Chih

Chong

Džavík

et al. 2023

Circ: Heart Failure

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BACKGROUND: Early cardiac allograft vasculopathy (CAV) prognostication is needed to improve long-term outcomes after heart transplantation. We characterized first year posttransplant coronary anatomic-physiologic alterations to determine predictors of early CAV progression. METHODS: Heart transplant recipients at 2 institutions (enrolled January 2018 to March 2021) underwent prospective evaluation 3 and 12-month posttransplant with angiography and left anterior descending artery intravascular ultrasound, optical coherence tomography, fractional flow reserve, coronary flow reserve, and index of microcirculatory resistance measurements. CAV progression was assessed by intravascular ultrasound change in percentage intimal volume from baseline to 12-month follow-up. RESULTS: Eighty-two patients (mean age, 51 years; 60% men) completed evaluation at mean 13.8 and 56.3 weeks posttransplant. Donor atherosclerosis (baseline intravascular ultrasound maximal intimal thickness, ≥0.5 mm) was evident in 50%. De novo (follow-up maximal intimal thickness, ≥0.5 mm) and rapidly progressive CAV (maximal intimal thickness, ≥0.5-mm increase from baseline) developed in 24% and 13%, respectively. On optical coherence tomography, baseline to follow-up median intimal volume increased 42% (0.58 mm 3 /mm), percentage intimal volume increased 44% (4.6%), vessel volume decreased 4% (−0.50 mm 3 /mm) and lumen volume decreased 9% (−1.02 mm 3 /mm); P <0.05 for all. Fibrotic plaque was the predominant morphology: baseline, 29% and follow-up, 50%. Coronary physiology was abnormal in 41% at baseline and 45% at follow-up, with 1 in 5 patients having microvascular dysfunction (index of microcirculatory resistance, ≥25). On multivariable linear regression analysis, recipient male sex, fibrotic plaque, and index of microcirculatory resistance were independent predictors of coronary disease progression. CONCLUSIONS: Fibrotic plaque on optical coherence tomography and index of microcirculatory resistance early posttransplant predict CAV progression in the first year of transplantation. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03217786.

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Section: Donor Atherosclerosis and Cav Progressionmentioning

confidence: 99%

Section: Donor Atherosclerosis and Cav Progressionmentioning

confidence: 99%

Section: Donor Atherosclerosis and Cav Progressionmentioning

confidence: 99%

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Fibrotic Plaque and Microvascular Dysfunction Predict Early Cardiac Allograft Vasculopathy Progression After Heart Transplantation: The Early Post Transplant Cardiac Allograft Vasculopathy Study

Chih

Chong

Džavík

et al. 2023

Circ: Heart Failure

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“…The pathogenesis is mostly due to various factors such as the invasion of cold pathogens, emotional disorders, aging and physical weakness, or improper diet. Therefore, TCM nursing is often based on the basic principles of first protecting vitality, regulating Qi and removing blood stasis, maintaining a happy mood, and maintaining liver balance [ 11 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

Intracoronary Ultrasound Imaging Combined with Traditional Chinese Medicine Nursing Applied in the Treatment of Coronary Heart Disease Patients with Phlegm and Blood Stasis Syndrome

Zhong

Guo

Yang

et al. 2022

Contrast Media & Molecular Imaging

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This study was to explore the effect of traditional Chinese medicine (TCM) nursing intervention based on intracoronary ultrasound imaging on patients with coronary heart disease (CHD) and phlegm and blood stasis syndrome (PBSS). 100 hospitalized patients with CHD with Qi deficiency and blood stasis syndrome (QDBSS) were rolled into the experimental (Exp) group (routine nursing intervention) and control (Ctrl) group (TCM nursing intervention, syndrome differentiation nursing), with 50 patients in each group. They underwent the intracoronary ultrasound imaging scanning. The results showed that after intervention, the plaque load (45.08 ± 6.02%), plaque eccentricity index (0.47 ± 0.08%), vascular remodeling index (0.53 ± 0.11%), and vascular external elastic membrane area (8.67 ± 3.06 mm2) of the Exp group were notably inferior to those of the Ctrl group (60.22 ± 5.82%, 0.59 ± 0.08%, 0.71 ± 0.09%, and 10.56 ± 2.31 mm2). The total effective rate in the Exp group (88%) was greatly superior to that of the Ctrl group (68%). In terms of TCM symptom scores, the TCM symptom scores of chest pain, chest tightness, and shortness of breath in the Exp group after intervention (1.07 ± 0.21 points, 0.75 ± 0.27 points, and 0.58 ± 0.12 points) were notably inferior to those in the Ctrl group (1.62 ± 0.28 points, 1.03 ± 0.21 points, and 0.79 ± 0.14 points). In the Exp group, after intervention, the degree of physical activity limitation (67.05 ± 5.08 points), the stable state of angina pectoris (65.28 ± 3.76 points), the frequency of angina pectoris attack (85.92 ± 2.97 points), the degree of treatment satisfaction (75.39 ± 5.94 points), the cognition score of disease (63.56 ± 5.84 points), the levels of triglyceride (1.27 ± 0.41 mmol/L), and total cholesterol (2.24 ± 0.41 mmol/L) were remarkably inferior to the Ctrl group (52.97 ± 4.31 points, 50.77 ± 4.69 points, 71.36 ± 3.77 points, 64.08 ± 5.64 points, 51.77 ± 6.33 points, 2.09 ± 0.57 mmol/L, and 3.06 ± 0.84 mmol/L) ( P < 0.05 ). It suggested that intracoronary ultrasound imaging can clearly display the coronary plaques of patients and accurately evaluate the clinical efficacy of patients with CHD. The TCM nursing program can greatly improve the angina symptoms and quality of life of patients with CHD and PBSS, reduce blood lipid levels, and effectively improve the clinical efficacy of patients.

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“…Among the distinguishing features of the ECAV study is the choice of IVUS-derived change in PIV as a surrogate clinical end point. Unlike change in maximal intimal thickness ≥0.5 mm, often termed rapidly-progressive CAV and variably demonstrated in other trials to predict clinical CAV events, 7,8 PIV reflects both changes in intimal volume and changes resulting from vessel remodeling, perhaps affording a more sensitive parameter for vessel evaluation. As the authors of the study correctly point out, neither the change in maximal intimal thickness nor rapidly-progressive CAV has established prognostic utility in the current HT era; importantly, however, neither does PIV or other IVUS-derived parameters like percent atheroma volume.…”

mentioning

confidence: 99%

Coronary Allograft Vasculopathy: From Predictably Unpredictable to Unpredictably Predictable

Schlendorf

2023

Circ: Heart Failure

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Influence of Donor Transmitted and Rapidly Progressive Coronary Vascular Disease on Long-Term Outcomes After Heart Transplantation: A Contemporary Intravascular Ultrasound Analysis

Cited by 16 publications

References 21 publications

Fibrotic Plaque and Microvascular Dysfunction Predict Early Cardiac Allograft Vasculopathy Progression After Heart Transplantation: The Early Post Transplant Cardiac Allograft Vasculopathy Study

Fibrotic Plaque and Microvascular Dysfunction Predict Early Cardiac Allograft Vasculopathy Progression After Heart Transplantation: The Early Post Transplant Cardiac Allograft Vasculopathy Study

Intracoronary Ultrasound Imaging Combined with Traditional Chinese Medicine Nursing Applied in the Treatment of Coronary Heart Disease Patients with Phlegm and Blood Stasis Syndrome

Coronary Allograft Vasculopathy: From Predictably Unpredictable to Unpredictably Predictable

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