Cardiogenic shock and coronary endothelial dysfunction predict cardiac allograft vasculopathy after heart transplantation.

Autor: Lopez-Fernandez S; Àrea de Malalties del Cor, Bellvitge University Hospital, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; Department of Cardiology, Virgen de las Nieves University Hospital, FIBAO, Granada, Spain., Manito-Lorite N, Gómez-Hospital JA, Roca J, Fontanillas C, Melgares-Moreno R, Azpitarte-Almagro J, Cequier-Fillat A
Jazyk: angličtina
Zdroj: Clinical transplantation [Clin Transplant] 2014 Dec; Vol. 28 (12), pp. 1393-401. Date of Electronic Publication: 2014 Nov 23.
DOI: 10.1111/ctr.12470
Abstrakt: Cardiac allograft vasculopathy remains one of the major causes of death post-heart transplantation. Its etiology is multifactorial and prevention is challenging. The aim of this study was to prospectively determine factors related to cardiac allograft vasculopathy after heart transplantation. This research was planned on 179 patients submitted to heart transplant. Performance of an early coronary angiography with endothelial function evaluation was scheduled at three-month post-transplant. Patients underwent a second coronary angiography after five-yr follow-up. At the 5- ± 2-yr follow-up, 43% of the patients had developed cardiac allograft vasculopathy (severe in 26% of them). Three independent predictors of cardiac allograft vasculopathy were identified: cardiogenic shock at the time of the transplant operation (OR: 6.49; 95% CI: 1.86-22.7, p = 0.003); early coronary endothelial dysfunction (OR: 3.9; 95% CI: 1.49-10.2, p = 0.006), and older donor age (OR: 1.05; 95% CI: 1.00-1.10, p = 0.044). Besides early endothelial coronary dysfunction and older donor age, a new predictor for development of cardiac allograft vasculopathy was identified: cardiogenic shock at the time of transplantation. In these high-risk patient subgroups, preventive measures (treatment of cardiovascular risk factors, use of novel immunosuppressive agents such as mTOR inhibitors) should be earlier and much more aggressive.
(© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)
Databáze: MEDLINE
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