Intravascular Ultrasound Evidence of Angiographically Silent Progression in Coronary Atherosclerosis Predicts Long-Term Morbidity and Mortality After Cardiac Transplantation
The aim of this study was to determine whether angiographically silent early coronary intimal thickening could predict long-term morbidity and mortality. Although intravascular ultrasound (IVUS) is widely used to detect early transplant coronary disease, its prognostic significance has not been well...
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| Veröffentlicht in: | Journal of the American College of Cardiology 2005-05, Vol.45 (9), p.1538-1542 |
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| creator | Tuzcu, E. Murat Kapadia, Samir R. Sachar, Ravish Ziada, Khaled M. Crowe, Timothy D. Feng, Jingyuan Magyar, William A. Hobbs, Robert E. Starling, Randall C. Young, James B. McCarthy, Patrick Nissen, Steven E. |
| description | The aim of this study was to determine whether angiographically silent early coronary intimal thickening could predict long-term morbidity and mortality.
Although intravascular ultrasound (IVUS) is widely used to detect early transplant coronary disease, its prognostic significance has not been well defined.
The study cohort consisted of 143 patients who underwent early multivessel (2.1 ± 0.7 arteries/patient) IVUS examination 1.0 ± 0.5 month and 12.0 ± 1.0 month after transplantation. The change in intimal thickness was evaluated using paired analysis of 1,069 matched sites. Rapidly progressive vasculopathy was defined as the change in intimal thickness ≥0.5 mm. Patients were followed for a primary end point of all-cause mortality and a secondary composite end point of mortality and nonfatal myocardial infarction (MI). Angiographic disease, defined as any ≥50% diameter stenosis, was assessed in 126 patients.
Intravascular ultrasound at one year demonstrated rapid progression in 54 (37%) of 143 patients and new lesions in 67 (47%) of 143 of patients. At a mean clinical follow-up of 5.9 years, more patients with rapidly progressive vasculopathy died, as compared with those without (26% vs. 11%, p = 0.03). Death and MI also occurred more frequently among those with rapid progression than in those without it (51% vs. 16%, p < 0.0001). There was no significant difference in outcome in patients with and without donor-transmitted lesions. Angiographic disease was found in 11 (22%) of 50 patients with and in 2 (2.1%) of 76 patients without (p = 0.003) rapidly progressive vasculopathy. The IVUS-defined rapid progression correlated highly with future development of angiographic disease (p = 0.0005).
Rapidly progressive vasculopathy by IVUS, defined as an increase of ≥0.5 mm in intimal thickness within the first year after transplantation, is a powerful predictor of all-cause mortality, MI, and angiographic abnormalities. Accordingly, such patients may be candidates for more aggressive anti-atherosclerotic and/or immunosuppressive therapy. |
| doi_str_mv | 10.1016/j.jacc.2004.12.076 |
| format | Article |
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Although intravascular ultrasound (IVUS) is widely used to detect early transplant coronary disease, its prognostic significance has not been well defined.
The study cohort consisted of 143 patients who underwent early multivessel (2.1 ± 0.7 arteries/patient) IVUS examination 1.0 ± 0.5 month and 12.0 ± 1.0 month after transplantation. The change in intimal thickness was evaluated using paired analysis of 1,069 matched sites. Rapidly progressive vasculopathy was defined as the change in intimal thickness ≥0.5 mm. Patients were followed for a primary end point of all-cause mortality and a secondary composite end point of mortality and nonfatal myocardial infarction (MI). Angiographic disease, defined as any ≥50% diameter stenosis, was assessed in 126 patients.
Intravascular ultrasound at one year demonstrated rapid progression in 54 (37%) of 143 patients and new lesions in 67 (47%) of 143 of patients. At a mean clinical follow-up of 5.9 years, more patients with rapidly progressive vasculopathy died, as compared with those without (26% vs. 11%, p = 0.03). Death and MI also occurred more frequently among those with rapid progression than in those without it (51% vs. 16%, p < 0.0001). There was no significant difference in outcome in patients with and without donor-transmitted lesions. Angiographic disease was found in 11 (22%) of 50 patients with and in 2 (2.1%) of 76 patients without (p = 0.003) rapidly progressive vasculopathy. The IVUS-defined rapid progression correlated highly with future development of angiographic disease (p = 0.0005).
Rapidly progressive vasculopathy by IVUS, defined as an increase of ≥0.5 mm in intimal thickness within the first year after transplantation, is a powerful predictor of all-cause mortality, MI, and angiographic abnormalities. Accordingly, such patients may be candidates for more aggressive anti-atherosclerotic and/or immunosuppressive therapy.</description><identifier>ISSN: 0735-1097</identifier><identifier>EISSN: 1558-3597</identifier><identifier>DOI: 10.1016/j.jacc.2004.12.076</identifier><identifier>PMID: 15862431</identifier><identifier>CODEN: JACCDI</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Adult ; Atherosclerosis (general aspects, experimental research) ; Biological and medical sciences ; Blood and lymphatic vessels ; Cardiology ; Cardiology. Vascular system ; Cholesterol ; Cohort Studies ; Coronary heart disease ; Coronary Vessels - diagnostic imaging ; Coronary Vessels - pathology ; Cytomegalovirus ; Disease Progression ; Disease-Free Survival ; Drug therapy ; Female ; Heart ; Heart attacks ; Heart Transplantation - mortality ; Humans ; Male ; Medical sciences ; Middle Aged ; Mortality ; Predictive Value of Tests ; Survival Analysis ; Transplants & implants ; Tunica Intima - diagnostic imaging ; Tunica Intima - pathology ; Ultrasonography, Interventional ; United States - epidemiology</subject><ispartof>Journal of the American College of Cardiology, 2005-05, Vol.45 (9), p.1538-1542</ispartof><rights>2005 American College of Cardiology Foundation</rights><rights>2005 INIST-CNRS</rights><rights>Copyright Elsevier Limited May 3, 2005</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c513t-1517467f5e50064a616720ed6f23223ba363b9b8aa20e266029b9028214ea4393</citedby><cites>FETCH-LOGICAL-c513t-1517467f5e50064a616720ed6f23223ba363b9b8aa20e266029b9028214ea4393</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0735109705004663$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=16765162$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/15862431$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Tuzcu, E. Murat</creatorcontrib><creatorcontrib>Kapadia, Samir R.</creatorcontrib><creatorcontrib>Sachar, Ravish</creatorcontrib><creatorcontrib>Ziada, Khaled M.</creatorcontrib><creatorcontrib>Crowe, Timothy D.</creatorcontrib><creatorcontrib>Feng, Jingyuan</creatorcontrib><creatorcontrib>Magyar, William A.</creatorcontrib><creatorcontrib>Hobbs, Robert E.</creatorcontrib><creatorcontrib>Starling, Randall C.</creatorcontrib><creatorcontrib>Young, James B.</creatorcontrib><creatorcontrib>McCarthy, Patrick</creatorcontrib><creatorcontrib>Nissen, Steven E.</creatorcontrib><title>Intravascular Ultrasound Evidence of Angiographically Silent Progression in Coronary Atherosclerosis Predicts Long-Term Morbidity and Mortality After Cardiac Transplantation</title><title>Journal of the American College of Cardiology</title><addtitle>J Am Coll Cardiol</addtitle><description>The aim of this study was to determine whether angiographically silent early coronary intimal thickening could predict long-term morbidity and mortality.
Although intravascular ultrasound (IVUS) is widely used to detect early transplant coronary disease, its prognostic significance has not been well defined.
The study cohort consisted of 143 patients who underwent early multivessel (2.1 ± 0.7 arteries/patient) IVUS examination 1.0 ± 0.5 month and 12.0 ± 1.0 month after transplantation. The change in intimal thickness was evaluated using paired analysis of 1,069 matched sites. Rapidly progressive vasculopathy was defined as the change in intimal thickness ≥0.5 mm. Patients were followed for a primary end point of all-cause mortality and a secondary composite end point of mortality and nonfatal myocardial infarction (MI). Angiographic disease, defined as any ≥50% diameter stenosis, was assessed in 126 patients.
Intravascular ultrasound at one year demonstrated rapid progression in 54 (37%) of 143 patients and new lesions in 67 (47%) of 143 of patients. At a mean clinical follow-up of 5.9 years, more patients with rapidly progressive vasculopathy died, as compared with those without (26% vs. 11%, p = 0.03). Death and MI also occurred more frequently among those with rapid progression than in those without it (51% vs. 16%, p < 0.0001). There was no significant difference in outcome in patients with and without donor-transmitted lesions. Angiographic disease was found in 11 (22%) of 50 patients with and in 2 (2.1%) of 76 patients without (p = 0.003) rapidly progressive vasculopathy. The IVUS-defined rapid progression correlated highly with future development of angiographic disease (p = 0.0005).
Rapidly progressive vasculopathy by IVUS, defined as an increase of ≥0.5 mm in intimal thickness within the first year after transplantation, is a powerful predictor of all-cause mortality, MI, and angiographic abnormalities. Accordingly, such patients may be candidates for more aggressive anti-atherosclerotic and/or immunosuppressive therapy.</description><subject>Adult</subject><subject>Atherosclerosis (general aspects, experimental research)</subject><subject>Biological and medical sciences</subject><subject>Blood and lymphatic vessels</subject><subject>Cardiology</subject><subject>Cardiology. Vascular system</subject><subject>Cholesterol</subject><subject>Cohort Studies</subject><subject>Coronary heart disease</subject><subject>Coronary Vessels - diagnostic imaging</subject><subject>Coronary Vessels - pathology</subject><subject>Cytomegalovirus</subject><subject>Disease Progression</subject><subject>Disease-Free Survival</subject><subject>Drug therapy</subject><subject>Female</subject><subject>Heart</subject><subject>Heart attacks</subject><subject>Heart Transplantation - mortality</subject><subject>Humans</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Predictive Value of Tests</subject><subject>Survival Analysis</subject><subject>Transplants & implants</subject><subject>Tunica Intima - diagnostic imaging</subject><subject>Tunica Intima - pathology</subject><subject>Ultrasonography, Interventional</subject><subject>United States - epidemiology</subject><issn>0735-1097</issn><issn>1558-3597</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2005</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kd-K1DAUxoso7rj6Al5IQPSuNX-atAVvhmHVhREFZ69DmqazKZlkTNKBeSjf0VNmYMELbxLO4XdyvnxfUbwluCKYiE9TNSmtK4pxXRFa4UY8K1aE87ZkvGueFyvcMF4S3DU3xauUJoyxaEn3srghvBW0ZmRV_Ln3OaqTSnp2KqIHB1UKsx_Q3ckOxmuDwojWfm_DPqrjo9XKuTP6ZZ3xGf2M0DUp2eCR9WgTYvAqntE6P5oYknbLaRNwZrA6J7QNfl_uTDyg7yH2drD5jBQsgyort1TrMZuINioOVmm0i8qno1M-qwxLXhcvRuWSeXO9b4uHL3e7zbdy--Pr_Wa9LTUnLJeEk6YWzcgNhy_XShDRUGwGMVJGKesVE6zv-lYp6FIhMO36DtOWktqomnXstvh4efcYw-_ZpCwPNmnjQIgJc5KiaTHHjAL4_h9wCnP0oE0SjmFvTTEDil4oDXakaEZ5jPYARkmC5RKlnOQSpVyilIRKiBKG3l2fnvuDGZ5GrtkB8OEKQHrKjWCVtumJE43gRCwaP184A46drIkyabskO9hodJZDsP_T8Rf-Vr7R</recordid><startdate>20050503</startdate><enddate>20050503</enddate><creator>Tuzcu, E. Murat</creator><creator>Kapadia, Samir R.</creator><creator>Sachar, Ravish</creator><creator>Ziada, Khaled M.</creator><creator>Crowe, Timothy D.</creator><creator>Feng, Jingyuan</creator><creator>Magyar, William A.</creator><creator>Hobbs, Robert E.</creator><creator>Starling, Randall C.</creator><creator>Young, James B.</creator><creator>McCarthy, Patrick</creator><creator>Nissen, Steven E.</creator><general>Elsevier Inc</general><general>Elsevier Science</general><general>Elsevier Limited</general><scope>6I.</scope><scope>AAFTH</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7TK</scope><scope>H94</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope></search><sort><creationdate>20050503</creationdate><title>Intravascular Ultrasound Evidence of Angiographically Silent Progression in Coronary Atherosclerosis Predicts Long-Term Morbidity and Mortality After Cardiac Transplantation</title><author>Tuzcu, E. 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Murat</au><au>Kapadia, Samir R.</au><au>Sachar, Ravish</au><au>Ziada, Khaled M.</au><au>Crowe, Timothy D.</au><au>Feng, Jingyuan</au><au>Magyar, William A.</au><au>Hobbs, Robert E.</au><au>Starling, Randall C.</au><au>Young, James B.</au><au>McCarthy, Patrick</au><au>Nissen, Steven E.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Intravascular Ultrasound Evidence of Angiographically Silent Progression in Coronary Atherosclerosis Predicts Long-Term Morbidity and Mortality After Cardiac Transplantation</atitle><jtitle>Journal of the American College of Cardiology</jtitle><addtitle>J Am Coll Cardiol</addtitle><date>2005-05-03</date><risdate>2005</risdate><volume>45</volume><issue>9</issue><spage>1538</spage><epage>1542</epage><pages>1538-1542</pages><issn>0735-1097</issn><eissn>1558-3597</eissn><coden>JACCDI</coden><abstract>The aim of this study was to determine whether angiographically silent early coronary intimal thickening could predict long-term morbidity and mortality.
Although intravascular ultrasound (IVUS) is widely used to detect early transplant coronary disease, its prognostic significance has not been well defined.
The study cohort consisted of 143 patients who underwent early multivessel (2.1 ± 0.7 arteries/patient) IVUS examination 1.0 ± 0.5 month and 12.0 ± 1.0 month after transplantation. The change in intimal thickness was evaluated using paired analysis of 1,069 matched sites. Rapidly progressive vasculopathy was defined as the change in intimal thickness ≥0.5 mm. Patients were followed for a primary end point of all-cause mortality and a secondary composite end point of mortality and nonfatal myocardial infarction (MI). Angiographic disease, defined as any ≥50% diameter stenosis, was assessed in 126 patients.
Intravascular ultrasound at one year demonstrated rapid progression in 54 (37%) of 143 patients and new lesions in 67 (47%) of 143 of patients. At a mean clinical follow-up of 5.9 years, more patients with rapidly progressive vasculopathy died, as compared with those without (26% vs. 11%, p = 0.03). Death and MI also occurred more frequently among those with rapid progression than in those without it (51% vs. 16%, p < 0.0001). There was no significant difference in outcome in patients with and without donor-transmitted lesions. Angiographic disease was found in 11 (22%) of 50 patients with and in 2 (2.1%) of 76 patients without (p = 0.003) rapidly progressive vasculopathy. The IVUS-defined rapid progression correlated highly with future development of angiographic disease (p = 0.0005).
Rapidly progressive vasculopathy by IVUS, defined as an increase of ≥0.5 mm in intimal thickness within the first year after transplantation, is a powerful predictor of all-cause mortality, MI, and angiographic abnormalities. Accordingly, such patients may be candidates for more aggressive anti-atherosclerotic and/or immunosuppressive therapy.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>15862431</pmid><doi>10.1016/j.jacc.2004.12.076</doi><tpages>5</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adult Atherosclerosis (general aspects, experimental research) Biological and medical sciences Blood and lymphatic vessels Cardiology Cardiology. Vascular system Cholesterol Cohort Studies Coronary heart disease Coronary Vessels - diagnostic imaging Coronary Vessels - pathology Cytomegalovirus Disease Progression Disease-Free Survival Drug therapy Female Heart Heart attacks Heart Transplantation - mortality Humans Male Medical sciences Middle Aged Mortality Predictive Value of Tests Survival Analysis Transplants & implants Tunica Intima - diagnostic imaging Tunica Intima - pathology Ultrasonography, Interventional United States - epidemiology |
| title | Intravascular Ultrasound Evidence of Angiographically Silent Progression in Coronary Atherosclerosis Predicts Long-Term Morbidity and Mortality After Cardiac Transplantation |
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