Prognostic Importance of Intimal Thickness as Measured by Intracoronary Ultrasound After Cardiac Transplantation

Abstract

These findings confirm the prognostic importance of mean intimal thickening of > 0.3 mm in heart transplant recipients and suggest that these patients should be candidates for early interventional strategies.

Serial Protocol Biopsies to Quantify the Progression of Chronic Transplant Nephropathy in Stable Renal Allografts

“…Furthermore, an association between pre-existing chronic vascular damage in the donor and decreased renal allograft survival has been described (11,12). These observations point out the importance of renal transplant vasculopathy as a major predictor of outcome and raise the question whether protocol biopsies could be employed to monitor the appearance and progression of transplant vasculopathy in the kidney in a similar way to how intracoronary ultrasounds have been employed in the heart (25). However, only a few arterial sections are obtained in a renal biopsy, as the sampling efficacy of this procedure is lower than intracoronary ecography.…”

Cardiac Allograft Vasculopathy: An Ongoing Challenge in the Care of Heart Transplant Recipients

“…IVUS can detect occult disease in angiographically normal sites and has emerged as the optimal diagnostic tool for early detection. CAV is considered present when the intimal thickness is >0.3mm (Rickenbacher et al, 1995). The presence of moderate to severe intimal thickening by IVUS is predictive of the future development of angiographically apparent CAV.…”

“…The presence of moderate to severe intimal thickening by IVUS is predictive of the future development of angiographically apparent CAV. IVUS-detected maximal intimal thickness (MIT) greater than 0.3mm at 1 year is associated with a 4-year actuarial survival of 73% versus 96% among those with less than 0.3mm of intimal thickening (Rickenbacher et al, 1995). A change in MIT of  0.5mm at a specific site in the coronary tree within the first year after transplant predicts outcomes at 5 years related to the development of angiographic CAV, mortality and myocardial infarction (Kobashigawa et al, 2005;Tuzcu et al, 2005).…”

A doença vascular do enxerto diagnosticada pela tomografia computadorizada de múltiplos detectores como preditora de eventos maiores em pacientes submetidos a transplante cardíaco

“…Como descrito por Nissen (2001), nas fases mais precoces da DVE, não ocorrerá comprometimento luminal devido ao remodelamento vascular, o que pode acabar acarretando perda diagnóstica pela cineangiocoronariografia que avalia o lúmen arterial (Rickenbacher et al, 1995).…”

“…O ultrassom intravascular (USIV) associado à cine é um método que têm auxiliado muito no diagnóstico da DVE, interferindo na história natural da doença e têm significado prognóstico (Rickenbacher et al, 1995;Tsutsui et al, 2001). Ele permite a avaliação em alta resolução do vaso, fornecendo informações do tamanho do lúmen, quantificação do espessamento e composição da parede Tsutsui et al, 2001).…”