Paradoxical Vessel Remodeling of the Proximal Segment of the Left Anterior Descending Artery Predicts Long-Term Mortality After Heart Transplantation

Kozo Okada, Hideki Kitahara, Hyoung Mo Yang, Shigemitsu Tanaka, Yuhei Kobayashi, Takumi Kimura, Helen Luikart, Paul G. Yock, Alan C. Yeung, Hannah A. Valantine, Peter J. Fitzgerald, Kiran K. Khush, Yasuhiro Honda, William F. Fearon

Research output: Contribution to journalArticlepeer-review

16 Scopus citations

Abstract

Objectives: This study investigated the association between arterial remodeling and geographic distribution of cardiac allograft vasculopathy (CAV), and outcomes after heart transplantation. Background: CAV is characterized by a combination of coronary intimal thickening and pathological vessel remodeling, which varies at different locations in coronary arteries. Methods: In 100 transplant recipients, serial volumetric intravascular ultrasonography (IVUS) was performed at baseline and 1 year post-transplantation in the first 50 mm of the left anterior descending artery (LAD). IVUS indices were evaluated in the entire segment and 3 equally divided LAD segments. Paradoxical vessel remodeling was defined as [δvessel volume/δintimal volume <0]. Results: After 1 year, death or re-transplantation occurred in 20 patients over a median follow-up period of 4.7 years. Paradoxical vessel remodeling was observed in 57%, 41%, 50%, and 40% for the entire vessel, proximal, middle, and distal LAD segments, respectively. Kaplan-Meier analysis revealed a significantly lower event-free rate of survival in patients with paradoxical vessel remodeling involving the proximal LAD segment, which was not present when involving the entire LAD or mid and distal LAD segments. In multivariate analysis, paradoxical vessel remodeling of the proximal LAD segment was independently associated with death or re-transplantation (hazard ratio [HR]: 11.18; 95% confidence interval [CI]: 2.39 to 83.23; p = 0.0015). Conclusions: Despite the diffuse nature of CAV, paradoxical vessel remodeling of the proximal LAD segment at 1 year was the primary determinant of long-term mortality or re-transplantation. Assessment of arterial remodeling combined with coronary intimal thickening may enhance identification of high-risk patients who may benefit from closer follow-up and targeted medical therapies.

Original languageEnglish (US)
Pages (from-to)942-952
Number of pages11
JournalJACC: Heart Failure
Volume3
Issue number12
DOIs
StatePublished - 2015
Externally publishedYes

Keywords

  • Cardiac transplant
  • Intravascular ultrasonography
  • Long-term mortality
  • Pathological remodeling
  • Vasculopathy

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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