Cor Vasa 2018, 60(1):e59-e65 | DOI: 10.1016/j.crvasa.2017.03.002

Early progression of cardiac allograft vasculopathy assessed by quantitative coronary angiography: A single centre prospective study

Radoslav Maxian^a,*, Josef Kautzner^a, Ivan Málek^a, Antonín Jabor^b, Janka Franeková^b, Vladimír Karmazín^a, Michael Želízko^a, Vojtěch Melenovský^a, Michal Pazderník^a

^a Klinika kardiologie, Institut klinické a experimentální medicíny, Praha, Česká republika

^b Pracoviště laboratorních metod, Institut klinické a experimentální medicíny, Praha, Česká republika

Introduction: Early diagnosis of cardiac allograft vasculopathy (CAV) becomes a crucial step in management of post-transplant patients since it can be attenuated by specific clinical approaches.

Materials and methods: We enrolled 48 consecutive patients in this prospective, observational, single centre study. Early development of CAV was assessed by two independent reviewers using quantitative coronary angiography (QCA) in the 1st and 12th month after heart transplantation (HTx). We examined the relationship between CAV and selected clinical and serological variables.

Results: A significant mean lumen diameter (MLD) loss was observed in all major coronary artery branches within 12 months after HTx. MLD loss was as follows - RCA (3.52 mm → 3.25 mm, p = 0.0008), LCx (3.68 mm → 3.42 mm, p < 0.0001) and LAD (3.95 mm → 3.69 mm, p < 0.0001). Among the patient cohort, 14 CAV rapid progressors (14/48, 29.2%) were identified. Their sum of MLD loss in all monitored arteries within 12 months after HTx reached ≥10%. An increased heart rate in the 12th month after HTx reflected the younger age of a donor (p = 0.01), but was not associated with rapid progression of CAV. The most important predictor of rapid progression of CAV was increased serum level of B-type natriuretic peptide (BNP) soon after HTx (3rd day after HTx, p = 0.04).

Conclusion: A significant reduction of MLD was observed in all major coronary arteries as early as within the first year after HTx. Early elevation of BNP serum levels predicted rapid progression of CAV. The presumption that faster heart rate is involved in the development of CAV in HTx recipients was not confirmed.

Keywords: B-type natriuretic peptide; Cardiac allograft vasculopathy; Quantitative coronary angiography; Tachycardia

Received: January 12, 2017; Revised: March 1, 2017; Accepted: March 2, 2017; Published: February 1, 2018  Show citation