(Circulation. 1995;92:3445-3452.)
© 1995 American Heart Association, Inc.
Articles |
Prognostic Importance of Intimal Thickness as Measured by Intracoronary Ultrasound After Cardiac Transplantation
Presented in part at the 67th Scientific Sessions of the American Heart Association, Dallas, Tex, November 14-17, 1994, and published in abstract form (Circulation. 1994;90[pt 2]).
From the Division of Cardiovascular Medicine, Department of Cardiothoracic Surgery (E.B.S.), and the Division of Biostatistics (B.W.B.), Stanford (Calif) University School of Medicine.
Correspondence to Hannah A. Valantine, MD, Stanford University School of Medicine, 300 Pasteur Dr, Stanford, CA 94305-5246.
Background Although intracoronary ultrasound (ICUS) has been validated for the early detection of transplant coronary artery disease (TxCAD), the prognostic importance of findings detected by this new imaging technique is unknown.
Methods and Results This study examined the relation of
clinical outcome in 145 heart transplant recipients (mean age,
45.1±11.1 years) with the amount of intimal thickness measured by ICUS
during routine annual coronary angiography 1 to 10 years (mean,
3.1±2.2 years) after transplantation. From published autopsy data, a
mean intimal thickness of >0.3 mm was considered significant. During a
mean follow-up time of 48.2±10.2 months, 23 deaths (12 cardiac)
occurred, and 6 patients required retransplantation. Angiographic TxCAD
developed in 22 of 125 patients (17.6%) in the subgroup with normal
angiograms at the time of ICUS and a follow-up annual angiographic
study. In the total population and the subgroup, mean intimal
thicknesses of >0.3 and 
0.3 mm, respectively, were associated with
significantly inferior 4-year actuarial overall survival
(73% versus 96%, P=.005; 72% versus 92%,
P=.05), cardiac survival (79% versus 96%,
P=.005; 80% versus 98%, P=.04), and freedom
from cardiac death and retransplantation (74% versus 98%,
P<.0001; 70% versus 96%, P=.001). In addition,
ICUS predicted freedom from development of subsequent angiographic
TxCAD in the subgroup that was initially normal (26% versus 72%,
P=.02). A mean intimal thickness by ICUS of >0.3 mm was
associated with inferior clinical outcome regardless of the
presence of angiographic TxCAD and predicted the development of
subsequent angiographic TxCAD. Despite significantly longer duration
after transplantation, higher rejection incidence, and lower average
daily cyclosporine dose, none of these covariates were
independent risk factors for outcome.
Conclusions 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.
Key Words: transplantation • ultrasonics • coronary disease • prognosis
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