Assessment of Cardiac Allograft Vasculopathy Late After Heart Transplantation: When Is Coronary Angiography Necessary?
| Autor: | Thomas M. Behr, Christiane E. Angermann, Christoph H. Spes, Michael Birk, Volker Klauss, Stefan Störk, Peter Überfuhr |
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| Rok vydání: | 2006 |
| Předmět: |
Adult
Male Pulmonary and Respiratory Medicine medicine.medical_specialty Multivariate analysis medicine.medical_treatment Antithrombin III Coronary Angiography Internal medicine Intravascular ultrasound medicine Humans Transplantation Homologous Lung transplantation Vascular Diseases Ultrasonography Interventional Heart transplantation Transplantation medicine.diagnostic_test business.industry Myocardium Respiratory disease Age Factors Middle Aged Prognosis medicine.disease Coronary Vessels Immunohistochemistry Tissue Donors Multivariate Analysis Angiography Heart–lung transplant cardiovascular system Cardiology Heart Transplantation Female Surgery Cardiology and Cardiovascular Medicine business Echocardiography Stress |
| Zdroj: | The Journal of Heart and Lung Transplantation. 25:1103-1108 |
| ISSN: | 1053-2498 |
| Popis: | 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. J Heart Lung Transplant 2006;25:1103– 8. Copyright © 2006 by the International Society for Heart and Lung Transplantation. |
| Databáze: | OpenAIRE |
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