Cardiovascular medicine
Progression of cardiac allograft vascular disease as assessed by
serial intravascular ultrasound: correlation to immunological and
non-immunological risk factors
K Pethiga, V Klaussb, B Heubleina, H Mudrab, A Westphala, C Weberb, K Theisenb, A Havericha
a Department
of Thoracic and Cardiovascular Surgery, Division of Surgery,
Hannover Medical School, D-30623 Hannover, Germany, b Department of Internal Medicine, Division of
Cardiology, Klinikum Innenstadt, University of Munich, Munich, Germany
Correspondence to: Dr Pethig Klaus.Pethig{at}thg.mh-hannover.de
Accepted 12 July 2000
OBJECTIVE
To characterise the
severity and progression of cardiac allograft vascular disease (CAVD)
in a large patient cohort, and to evaluate possible immunological
and non-immunological risk factors for progression.
DESIGNA prospective observational
study using intravascular ultrasound.
SETTINGTwo university hospitals.
PATIENTS AND MAIN OUTCOME
MEASURESChanges in focal plaque, lumen, and total vessel area
(worst site method) were assessed at baseline and after 12.1 (2.8)
months (mean (SD)) of follow up in a cohort of 96 patients (79 male, 17 female; mean age 48.7 (9.6) years; time post-transplant 26.0 (32.4) months).
RESULTSOverall, the mean (SD)
intimal index of worst sites increased by 6.7 (8.8)%. The increase in
the first 12 months was 7.5 (9.4)%, v 5.9 (8.0)% after the first year (NS). Analysing immunological and
non-immunological risk factors (age, underlying disease, sex, donor
age, immunosuppression, cytomegalovirus, rejection episodes, cholesterol), low density lipoprotein (LDL) cholesterol was found to be the most important predictor of severe progression (as defined by
an increase in intimal index of 
15% (p = 0.01).
CONCLUSIONSProgression of CAVD is
characterised by a continuing increase in intimal hyperplasia,
especially within the first year after heart transplantation. LDL
cholesterol is an important predictor of major progression.
Keywords: heart transplantation; cardiac allograft vasculopathy; intravascular ultrasound
© 2000 by Heart
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