BACKGROUND: Cardiac allograft vasculopathy (CAV) represents a major prognostic factor in long-term survivors of heart transplantation (HTx). Reliable diagnosis of CAV late after HTx is important but remains the domain of invasive techniques such as coronary angiography. METHODS: To test alternative approaches, 54 consecutive HTx recipients (mean time since HTx: 52 months) were studied with intravascular ultrasound (IVUS), angiography, dobutamine stress echocardiography and immunofluorescence staining against anti-thrombin III (AT-III) in endomyocardial biopsies. Univariate and multivariate predictors as well as receiver-operating-characteristic (ROC) curves of different sets of predictors were calculated. RESULTS: Using IVUS as reference standard, CAV was present in 80% of subjects. Coronary angiography identified CAV correctly in only 44% of cases. If AT-III staining alone was used as a diagnostic criterion, CAV was correctly identified in 77% of subjects. In a multivariate analysis, only AT-III, donor age and echocardiography at rest emerged as independent predictors of CAV (p < 0.05 for all), yielding an excellent discriminative power. CONCLUSIONS: With almost equal reliability when compared with IVUS, CAV can be identified using information on donor age, wall motion score at rest and AT-III staining late after HTx. Coronary angiography may be limited to patients with a high probability score and should not be used routinely for surveillance of CAV.
BACKGROUND:Cardiac allograft vasculopathy (CAV) represents a major prognostic factor in long-term survivors of heart transplantation (HTx). Reliable diagnosis of CAV late after HTx is important but remains the domain of invasive techniques such as coronary angiography. METHODS: To test alternative approaches, 54 consecutive HTx recipients (mean time since HTx: 52 months) were studied with intravascular ultrasound (IVUS), angiography, dobutamine stress echocardiography and immunofluorescence staining against anti-thrombin III (AT-III) in endomyocardial biopsies. Univariate and multivariate predictors as well as receiver-operating-characteristic (ROC) curves of different sets of predictors were calculated. RESULTS: Using IVUS as reference standard, CAV was present in 80% of subjects. Coronary angiography identified CAV correctly in only 44% of cases. If AT-III staining alone was used as a diagnostic criterion, CAV was correctly identified in 77% of subjects. In a multivariate analysis, only AT-III, donor age and echocardiography at rest emerged as independent predictors of CAV (p < 0.05 for all), yielding an excellent discriminative power. CONCLUSIONS: With almost equal reliability when compared with IVUS, CAV can be identified using information on donor age, wall motion score at rest and AT-III staining late after HTx. Coronary angiography may be limited to patients with a high probability score and should not be used routinely for surveillance of CAV.
Authors: Bo Zheng; Akiko Maehara; Gary S Mintz; Tamim M Nazif; Yarden Waksman; Fuyu Qiu; Luz Jaquez; LeRoy E Rabbani; Mark A Apfelbaum; Ziad A Ali; Kate Dalton; Lei Song; Ke Xu; Charles C Marboe; Donna M Mancini; Giora Weisz Journal: Int J Cardiovasc Imaging Date: 2015-09-25 Impact factor: 2.357
Authors: C Sciaccaluga; N Ghionzoli; G E Mandoli; N Sisti; F D'Ascenzi; M Focardi; S Bernazzali; G Vergaro; M Emdin; S Valente; M Cameli Journal: Heart Fail Rev Date: 2021-08-12 Impact factor: 4.654
Authors: Franz von Ziegler; Alexander W Leber; Alexander Becker; Ingo Kaczmarek; Ulf Schönermarck; Christine Raps; Janine Tittus; Peter Uberfuhr; Christoph R Becker; Maximilian Reiser; Gerhard Steinbeck; Andreas Knez Journal: Int J Cardiovasc Imaging Date: 2008-07-19 Impact factor: 2.357
Authors: Carlos A Labarrere; John R Woods; James W Hardin; Gonzalo L Campana; Miguel A Ortiz; Beate R Jaeger; Lee Ann Baldridge; Douglas E Pitts; Philip C Kirlin Journal: PLoS One Date: 2012-04-25 Impact factor: 3.240