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Weis M, Weis M. Transplant Vasculopathy Versus Native Atherosclerosis: Similarities and Differences. Transplantation 2024; 108:1342-1349. [PMID: 37899386 DOI: 10.1097/tp.0000000000004853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
Cardiac allograft vasculopathy (CAV) is one of the leading causes of graft failure and death after heart transplantation. Alloimmune-dependent and -independent factors trigger the pathogenesis of CAV through activation of the recipients' (and to a lesser extent donor-derived) immune system. Early diagnosis of CAV is complicated by the lack of clinical symptoms for ischemia in the denervated heart, by the impact of early functional coronary alterations, by the insensitivity of coronary angiography, and by the involvement of small intramyocardial vessels. CAV in general is a panarterial disease confined to the allograft and characterized by diffuse concentric longitudinal intimal hyperplasia in the epicardial coronary arteries and concentric medial disease in the microvasculature. Plaque composition in CAV may include early fibrous and fibrofatty tissue and late atheromatous calcification. In contrast, native coronary atherosclerosis usually develops over decades, is focal, noncircumferential, and typically diminishes proximal parts of the epicardial vessels. The rapid and early development of CAV has an adverse prognostic impact, and current prevention and treatment strategies are of limited efficacy compared with established strategies in native atherosclerosis. Following acute coronary syndromes, patients after heart transplantation were more likely to have accompanying cardiogenic shock and higher mortality compared with acute coronary syndromes patients with native hearts.
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Affiliation(s)
- Michael Weis
- Department of Internal Medicine I, Krankenhaus Neuwittelsbach, Munich, Germany
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von Scheidt W, Reichart B, Meiser B, von Scheidt M, Sen P, Schwarz F, Harmel E, Bengel FM, Dick A, Ueberfuhr P, Reichenspurner H, Jaeckel E, Schwinzer R, Hagl C. Unique 40-year survival after heart transplantation with normal graft function and spontaneous operational tolerance. Clin Res Cardiol 2024; 113:661-671. [PMID: 37982861 PMCID: PMC11026283 DOI: 10.1007/s00392-023-02341-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 11/07/2023] [Indexed: 11/21/2023]
Abstract
Unique 40-year survival after heart transplantation with normal graft function and spontaneous operational tolerance.
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Affiliation(s)
- Wolfgang von Scheidt
- I.Medizinische Klinik, University Hospital Augsburg, University of Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany.
- Ludwig-Maximilians-University Munich, Munich, Germany.
| | - Bruno Reichart
- Department of Cardiac Surgery, University Hospital Großhadern, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Bruno Meiser
- Transplant Center, University Hospital Großhadern, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Moritz von Scheidt
- Department of Cardiovascular Diseases, German Heart Center Munich, Technical University Munich, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Partho Sen
- Department of Cardiovascular Diseases, German Heart Center Munich, Technical University Munich, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Florian Schwarz
- Ludwig-Maximilians-University Munich, Munich, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, University of Augsburg, Augsburg, Germany
| | - Eva Harmel
- I.Medizinische Klinik, University Hospital Augsburg, University of Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany
| | - Frank M Bengel
- Department of Nuclear Medicine, Hannover Medical School, Hannover, Germany
| | - Andrea Dick
- Laboratory for Immunogenetics and Molecular Diagnostics, University Hospital Großhadern, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Peter Ueberfuhr
- Department of Cardiac Surgery, University Hospital Großhadern, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Hermann Reichenspurner
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Elmar Jaeckel
- Ajmera Transplant Center, UHN, University of Toronto, Toronto, Canada
| | - Reinhard Schwinzer
- Department of General-, Visceral- and Transplantation-Surgery, Hannover Medical School, Hannover, Germany
| | - Christian Hagl
- Department of Cardiac Surgery, University Hospital Großhadern, Ludwig-Maximilians-University Munich, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
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3
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de Souza JAF, Catai AM, de Moura-Tonello SCG, Araújo BTS, Barros AEVR, de Aguiar MIR, Campos SL, de Andrade AD, Brandão DC. Correlation between peripheral endothelial function, oxygen consumption and ventilatory efficiency in heart transplantation recipients. Heart Lung 2024; 64:208-213. [PMID: 38092582 DOI: 10.1016/j.hrtlng.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 11/09/2023] [Accepted: 11/14/2023] [Indexed: 03/18/2024]
Abstract
BACKGROUND Endothelial dysfunction and peak oxygen uptake (VO2peak) are also predictors of increased risk of cardiovascular events in heart transplantation (HTx) recipients. The preservation of endothelial function may contribute to exercise tolerance. OBJECTIVE To investigate the correlation between peripheral endothelial function and exercise tolerance through VO2peak and ventilation to carbon dioxide production slope (VE / VCO2 slope) in HTx recipients. METHODS A pilot cross-sectional study was conducted with adult individuals aged 18-65 years, HTx ≥ six months after surgery, who had a stable medical condition and no changes over the last three months of immunosuppressive treatment. The patients underwent an assessment of endothelial function through PAT (EndoPAT-2000®) and performed a cardiopulmonary exercise test (CPET). RESULTS A total of 41% of the studied population presented endothelial dysfunction. The individuals were divided into two groups: the endothelial dysfunction (GED; n=9) group and the normal endothelial function (GNEF; n=13) group according to the logarithm of the reactive hyperemia index (LnRHI). There was a positive and moderate correlation between the LnRHI and VO2 peak (r=0.659, p=0.013) and a negative and moderate correlation between the LnRHI and VE/VCO2 slope (r= -0.686, p= 0.009) in the GNEF. However, no significant correlations were found in the GED. CONCLUSION The results showed that the preservation of peripheral endothelial function is significantly correlated with an increase in exercise tolerance in individuals after HTx. These findings bring important considerations for cardiovascular risk prevention and emphasize that therapeutic strategies with physical training programs must be implemented early.
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Affiliation(s)
| | - Aparecida Maria Catai
- Physiotherapy Department, Federal University of Sao Carlos (UFSCAR), São Carlos, Brazil
| | | | - Bruna T S Araújo
- Physiotherapy Department, Federal University of Pernambuco (UFPE), Recife, Brazil
| | | | | | - Shirley Lima Campos
- Physiotherapy Department, Federal University of Pernambuco (UFPE), Recife, Brazil
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4
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Ahn Y, Koo HJ, Hyun J, Lee SE, Jung SH, Park DW, Ahn JM, Kang DY, Park SJ, Hwang HS, Kang JW, Yang DH, Kim JJ. CT Coronary Angiography and Dynamic CT Myocardial Perfusion for Detection of Cardiac Allograft Vasculopathy. JACC Cardiovasc Imaging 2023; 16:934-947. [PMID: 37407125 DOI: 10.1016/j.jcmg.2022.12.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 12/23/2022] [Indexed: 07/07/2023]
Abstract
BACKGROUND Cardiac allograft vasculopathy (CAV) is a major obstacle limiting long-term graft survival. Effective noninvasive surveillance modalities reflecting both coronary artery and microvascular components of CAV are needed. OBJECTIVES The authors evaluated the diagnostic performance of dynamic computed tomography-myocardial perfusion imaging (CT-MPI) and coronary computed tomography angiography (CCTA) for CAV. METHODS A total of 63 heart transplantation patients underwent combined CT-MPI and CCTA plus invasive coronary angiography (ICA) with intravascular ultrasonography (IVUS) between December 2018 and October 2021. The median interval between CT-MPI and heart transplantation was 4.3 years. Peak myocardial blood flow (MBF) of the whole myocardium (MBFglobal) and minimum MBF (MBFmin) among the 16 segments according to the American Heart Association model, except the left ventricular apex, were calculated from CT-MPI. CCTA was assessed qualitatively, and the degree of coronary artery stenosis was recorded. CAV was diagnosed based on both ICA (ISHLT criteria) and IVUS. Patients were followed up for a median time of 2.3 years after CT-MPI and a median time of 5.7 years after transplantation. RESULTS Among the 63 recipients, 35 (55.6%) had diagnoses of CAV. The median MBFglobal and MBFmin were significantly lower in patients with CAV (128.7 vs 150.4 mL/100 mL/min; P = 0.014; and 96.9 vs 122.8 mL/100 mL/min; P < 0.001, respectively). The combined use of coronary artery stenosis on CCTA and MBFmin showed the highest diagnostic performance with an area under the curve of 0.886 (sensitivity: 74.3%, specificity: 96.4%, positive predictive value: 96.3%, and negative predictive value: 75.0%). CONCLUSIONS The combination of CT-MPI and CCTA demonstrated excellent diagnostic performance for the detection of CAV. One-stop evaluation of the coronary artery and microvascular components involved in CAV using combined CCTA and CT-MPI may be a potent noninvasive screening method for early detection of CAV.
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Affiliation(s)
- Yura Ahn
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Hyun Jung Koo
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
| | - Junho Hyun
- Division of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Sang Eun Lee
- Division of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Sung Ho Jung
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Duk-Woo Park
- Division of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jung-Min Ahn
- Division of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Do-Yoon Kang
- Division of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Seung-Jung Park
- Division of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Hee Sang Hwang
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Joon-Won Kang
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Dong Hyun Yang
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jae-Joong Kim
- Division of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Abbasi MA, Blake AM, Sarnari R, Lee D, Anderson AS, Ghafourian K, Khan SS, Vorovich EE, Rich JD, Wilcox JE, Yancy CW, Carr JC, Markl M. Multiparametric Cardiac Magnetic Resonance Imaging Detects Altered Myocardial Tissue and Function in Heart Transplantation Recipients Monitored for Cardiac Allograft Vasculopathy. J Cardiovasc Imaging 2022; 30:263-275. [PMID: 36280267 PMCID: PMC9592247 DOI: 10.4250/jcvi.2022.0003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 04/26/2022] [Accepted: 05/02/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Cardiac allograft vasculopathy (CAV) is a complication beyond the first-year post-heart transplantation (HTx). We aimed to test the utility of cardiac magnetic resonance (CMR) to detect functional/structural changes in HTx recipients with CAV. METHODS Seventy-seven prospectively recruited HTx recipients beyond the first-year post-HTx and 18 healthy controls underwent CMR, including cine imaging of ventricular function and T1- and T2-mapping to assess myocardial tissue changes. Data analysis included quantification of global cardiac function and regional T2, T1 and extracellular volume based on the 16-segment model. International Society for Heart and Lung Transplantation criteria was used to adjudicate CAV grade (0–3) based on coronary angiography. RESULTS The majority of HTx recipients (73%) presented with CAV (1: n = 42, 2/3: n = 14, 0: n = 21). Global and segmental T2 (49.5 ± 3.4 ms vs 50.6 ± 3.4 ms, p < 0.001;16/16 segments) were significantly elevated in CAV-0 compared to controls. When comparing CAV-2/3 to CAV-1, global and segmental T2 were significantly increased (53.6 ± 3.2 ms vs. 50.6 ± 2.9 ms, p < 0.001; 16/16 segments) and left ventricular ejection fraction was significantly decreased (54 ± 9% vs. 59 ± 9%, p < 0.05). No global, structural, or functional differences were seen between CAV-0 and CAV-1. CONCLUSIONS Transplanted hearts display functional and structural alteration compared to native hearts, even in those without evidence of macrovasculopathy (CAV-0). In addition, CMR tissue parameters were sensitive to changes in CAV-1 vs. 2/3 (mild vs. moderate/severe). Further studies are warranted to evaluate the diagnostic value of CMR for the detection and classification of CAV.
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Affiliation(s)
- Muhannad A. Abbasi
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Allison M. Blake
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Roberto Sarnari
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Daniel Lee
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Allen S. Anderson
- Division of Cardiology, Department of Medicine, Northwestern University, Chicago, IL, USA
| | - Kambiz Ghafourian
- Division of Cardiology, Department of Medicine, Northwestern University, Chicago, IL, USA
| | - Sadiya S. Khan
- Division of Cardiology, Department of Medicine, Northwestern University, Chicago, IL, USA
| | - Esther E. Vorovich
- Division of Cardiology, Department of Medicine, Northwestern University, Chicago, IL, USA
| | - Jonathan D. Rich
- Division of Cardiology, Department of Medicine, Northwestern University, Chicago, IL, USA
| | - Jane E. Wilcox
- Division of Cardiology, Department of Medicine, Northwestern University, Chicago, IL, USA
| | - Clyde W. Yancy
- Division of Cardiology, Department of Medicine, Northwestern University, Chicago, IL, USA
| | - James C. Carr
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Michael Markl
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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6
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Effect of exercise on endothelial function in heart transplant recipients: systematic review and meta-analysis. Heart Fail Rev 2021; 25:487-494. [PMID: 31808028 DOI: 10.1007/s10741-019-09877-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Endothelial dysfunction is associated with increased cardiovascular risk and death in heart transplant recipients (HTx). Although the measurement of peripheral endothelial function is considered a significant predictor of cardiovascular events in several populations, few studies have investigated this outcome after therapeutic strategies, including different exercise types, duration, and intensity. This systematic review and meta-analysis aimed to investigate the effects of continuous moderate exercise (CON) or high-intensity interval training (HIIT) to improve endothelial function (EF) in HTx. The search was conducted in Cochrane Central Registry of Controlled Trials (CENTRAL), MEDLINE (via PubMed), Web of Science and Scopus/Elsevier, CINAHL/Ebsco, Physiotherapy Evidence Database (PEDro), LILACS/BIREME, and SciELO databases. Quality of the evidence was assessed using the Grading of Recommendations Assessment Development and Evaluation (GRADE). The search strategy retrieved 5192 titles. A total of four articles met the inclusion criteria and were included for the qualitative analysis. Meta-analysis showed that exercises improved EF ([mean difference-MD] 3.48 95% CI - 0.29 to 7.25, p = 0.007) when compared with the control. However, there was a poor quality of evidence to demonstrate that CON or HIIT is better than usual care to improve EF. Exercise training provides benefits to patients, but the poor quality of evidence does not allow us to state that exercise is related to endothelial function improvement in HTx.
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7
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Alem MM. Endothelial Dysfunction in Chronic Heart Failure: Assessment, Findings, Significance, and Potential Therapeutic Targets. Int J Mol Sci 2019; 20:E3198. [PMID: 31261886 PMCID: PMC6651535 DOI: 10.3390/ijms20133198] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 06/13/2019] [Accepted: 06/25/2019] [Indexed: 12/11/2022] Open
Abstract
Chronic heart failure (CHF) is a complex syndrome that results from structural and functional disturbances that affect the ability of the heart to supply oxygen to tissues. It largely affects and reduces the patient's quality of life, socio-economic status, and imposes great costs on health care systems worldwide. Endothelial dysfunction (ED) is a newly discovered phenomenon that contributes greatly to the pathophysiology of numerous cardiovascular conditions and commonly co-exists with chronic heart failure. However, the literature lacks clarity as to which heart failure patients might be affected, its significance in CHF patients, and its reversibility with pharmacological and non-pharmacological means. This review will emphasize all these points and summarize them for future researchers interested in vascular pathophysiology in this particular patient population. It will help to direct future studies for better characterization of these two phenomena for the potential discovery of therapeutic targets that might reduce future morbidity and mortality in this "at risk" population.
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Affiliation(s)
- Manal M Alem
- Department of Pharmacology, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia.
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8
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Murthy VL, Bateman TM, Beanlands RS, Berman DS, Borges-Neto S, Chareonthaitawee P, Cerqueira MD, deKemp RA, DePuey EG, Dilsizian V, Dorbala S, Ficaro EP, Garcia EV, Gewirtz H, Heller GV, Lewin HC, Malhotra S, Mann A, Ruddy TD, Schindler TH, Schwartz RG, Slomka PJ, Soman P, Di Carli MF, Einstein A, Russell R, Corbett JR. Clinical Quantification of Myocardial Blood Flow Using PET: Joint Position Paper of the SNMMI Cardiovascular Council and the ASNC. J Nucl Cardiol 2018; 25:269-297. [PMID: 29243073 DOI: 10.1007/s12350-017-1110-x] [Citation(s) in RCA: 133] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Venkatesh L Murthy
- Frankel Cardiovascular Center, Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
| | | | - Rob S Beanlands
- National Cardiac PET Centre, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Daniel S Berman
- Departments of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Salvador Borges-Neto
- Division of Nuclear Medicine, Department of Radiology, and Division of Cardiology, Department of Medicine, Duke University School of Medicine, Duke University Health System, Durham, NC, USA
| | | | | | - Robert A deKemp
- National Cardiac PET Centre, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - E Gordon DePuey
- Division of Nuclear Medicine, Department of Radiology, Mt. Sinai St. Luke's and Mt. Sinai West Hospitals, Icahn School of Medicine at Mt. Sinai, New York, NY, USA
| | - Vasken Dilsizian
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Sharmila Dorbala
- Cardiovascular Imaging Program, Brigham and Women's Hospital, Boston, MA, USA
| | - Edward P Ficaro
- Division of Nuclear Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Ernest V Garcia
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, USA
| | - Henry Gewirtz
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Gary V Heller
- Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ, USA
| | | | - Saurabh Malhotra
- Division of Cardiovascular Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | | | - Terrence D Ruddy
- National Cardiac PET Centre, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Thomas H Schindler
- Division of Nuclear Medicine, Department of Radiology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Ronald G Schwartz
- Cardiology Division, Department of Medicine, and Nuclear Medicine Division, Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Piotr J Slomka
- Departments of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Prem Soman
- Division of Cardiology, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Marcelo F Di Carli
- Cardiovascular Imaging Program, Brigham and Women's Hospital, Boston, MA, USA
| | - Andrew Einstein
- Division of Cardiology, Department of Medicine, and Department of Radiology, Columbia University Medical Center and New York-Presbyterian Hospital, New York, NY, USA
| | - Raymond Russell
- Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - James R Corbett
- Frankel Cardiovascular Center, Division of Cardiovascular Medicine, Department of Internal Medicine, and Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, MI, USA
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9
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Murthy VL, Bateman TM, Beanlands RS, Berman DS, Borges-Neto S, Chareonthaitawee P, Cerqueira MD, deKemp RA, DePuey EG, Dilsizian V, Dorbala S, Ficaro EP, Garcia EV, Gewirtz H, Heller GV, Lewin HC, Malhotra S, Mann A, Ruddy TD, Schindler TH, Schwartz RG, Slomka PJ, Soman P, Di Carli MF. Clinical Quantification of Myocardial Blood Flow Using PET: Joint Position Paper of the SNMMI Cardiovascular Council and the ASNC. J Nucl Med 2017; 59:273-293. [PMID: 29242396 DOI: 10.2967/jnumed.117.201368] [Citation(s) in RCA: 147] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 09/11/2017] [Indexed: 12/30/2022] Open
Affiliation(s)
- Venkatesh L Murthy
- Frankel Cardiovascular Center, Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | | | - Rob S Beanlands
- National Cardiac PET Centre, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Daniel S Berman
- Departments of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Salvador Borges-Neto
- Division of Nuclear Medicine, Department of Radiology, and Division of Cardiology, Department of Medicine, Duke University School of Medicine, Duke University Health System, Durham, North Carolina
| | | | | | - Robert A deKemp
- National Cardiac PET Centre, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - E Gordon DePuey
- Division of Nuclear Medicine, Department of Radiology, Mt. Sinai St. Luke's and Mt. Sinai West Hospitals, Icahn School of Medicine at Mt. Sinai, New York, New York
| | - Vasken Dilsizian
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Sharmila Dorbala
- Cardiovascular Imaging Program, Brigham and Women's Hospital, Boston, Massachusetts
| | - Edward P Ficaro
- Division of Nuclear Medicine, University of Michigan, Ann Arbor, Michigan
| | - Ernest V Garcia
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia
| | - Henry Gewirtz
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Gary V Heller
- Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ, USA
| | | | - Saurabh Malhotra
- Division of Cardiovascular Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - April Mann
- Hartford Hospital, Hartford, Connecticut
| | - Terrence D Ruddy
- National Cardiac PET Centre, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Thomas H Schindler
- Division of Nuclear Medicine, Department of Radiology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Ronald G Schwartz
- Cardiology Division, Department of Medicine, and Nuclear Medicine Division, Department of Imaging Sciences, University of Rochester Medical Center, Rochester, New York; and
| | - Piotr J Slomka
- Departments of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Prem Soman
- Division of Cardiology, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Marcelo F Di Carli
- Cardiovascular Imaging Program, Brigham and Women's Hospital, Boston, Massachusetts
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10
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Foroutan F, Alba AC, Guyatt G, Duero Posada J, Ng Fat Hing N, Arseneau E, Meade M, Hanna S, Badiwala M, Ross H. Predictors of 1-year mortality in heart transplant recipients: a systematic review and meta-analysis. Heart 2017; 104:151-160. [DOI: 10.1136/heartjnl-2017-311435] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 04/17/2017] [Accepted: 06/06/2017] [Indexed: 11/04/2022] Open
Abstract
ObjectiveA systematic summary of the observational studies informing heart transplant guideline recommendations for selection of candidates and donors has thus far been unavailable. We performed a meta-analysis to better understand the impact of such known risk factors.MethodsWe systematically searched and meta-analysed the association between known pretransplant factor and 1-year mortality identified by multivariable regression models. Our review used the Grading of Recommendations, Assessment, Development and Evaluation for assessing the quality of assessment. We pooled risk estimates by using random effects models.ResultsRecipient variables including age (HR 1.16 per 10-year increase, 95% CI 1.10–1.22, high quality), congenital aetiology (HR 2.35, 95% CI 1.62 to 3.41, moderate quality), diabetes (HR 1.37, 95% CI 1.15 to 1.62, high quality), creatinine (HR 1.11 per 1 mg/dL increase, 95% CI 1.06 to 1.16, high quality), mechanical ventilation (HR 2.46, 95% CI 1.48 to 4.09, low quality) and short-term mechanical circulatory support (MCS) (HR 2.47, 95% CI 1.04 to 5.87, low quality) were significantly associated with 1-year mortality. Donor age (HR 1.20 per 10-year increase, 95% CI 1.14 to 1.26, high quality) and female donor to male recipient sex mismatch (HR 1.38, 95% CI 1.06 to 1.80, high quality) were significantly associated with 1-year mortality. None of the operative factors proved significant predictors.ConclusionHigh-quality and moderate-quality evidence demonstrates that recipient age, congenital aetiology, creatinine, pulsatile MCS, donor age and female donor to male recipient sex mismatch are associated with 1-year mortality post heart transplant. The results of this study should inform future guideline and predictive model development.
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11
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Ma S, Jiang Y, Huang W, Li X, Li S. Role of Transient Receptor Potential Channels in Heart Transplantation: A Potential Novel Therapeutic Target for Cardiac Allograft Vasculopathy. Med Sci Monit 2017; 23:2340-2347. [PMID: 28516902 PMCID: PMC5444344 DOI: 10.12659/msm.901920] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Heart transplantation has evolved as the criterion standard therapy for end-stage heart failure, but its efficacy is limited by the development of cardiac allograft vasculopathy (CAV), a unique and rapidly progressive form of atherosclerosis in heart transplant recipients. Here, we briefly review the key processes in the development of CAV during heart transplantation and highlight the roles of transient receptor potential (TRP) channels in these processes during heart transplantation. Understanding the roles of TRP channels in contributing to the key procedures for the development of CAV during heart transplantation could provide basic scientific knowledge for the development of new preventive and therapeutic approaches to manage patients with CAV after heart transplantation.
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Affiliation(s)
- Shuo Ma
- Department of Physiology, Dalian Medical University, Dalian, Liaoning, China (mainland).,The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China (mainland)
| | - Yue Jiang
- Department of Physiology, Dalian Medical University, Dalian, Liaoning, China (mainland).,The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China (mainland)
| | - Weiting Huang
- The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China (mainland)
| | - Xintao Li
- Department of Physiology, Dalian Medical University, Dalian, Liaoning, China (mainland).,The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China (mainland)
| | - Shuzhuang Li
- Department of Physiology, Dalian Medical University, Dalian, China (mainland)
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Platelet-derived Growth Factor-B Protects Rat Cardiac Allografts From Ischemia-reperfusion Injury. Transplantation 2016; 100:303-13. [PMID: 26371596 DOI: 10.1097/tp.0000000000000909] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Microvascular dysfunction and cardiomyocyte injury are hallmarks of ischemia-reperfusion injury (IRI) after heart transplantation. Platelet-derived growth factors (PDGF) have an ambiguous role in this deleterious cascade. On one hand, PDGF may exert vascular stabilizing and antiapoptotic actions through endothelial-pericyte and endothelial-cardiomyocyte crosstalk in the heart; and on the other hand, PDGF signaling mediates neointimal formation and exacerbates chronic rejection in cardiac allografts. The balance between these potentially harmful and beneficial actions determines the final outcome of cardiac allografts. METHODS AND RESULTS We transplanted cardiac allografts from Dark Agouti rat and Balb mouse donors to fully major histocompatibility complex-mismatched Wistar Furth rat or C57 mouse recipients with a clinically relevant 2-hour cold ischemia and 1-hour warm ischemia. Ex vivo intracoronary delivery of adenovirus-mediated gene transfer of recombinant human PDGF-BB upregulated messenger RNA expression of anti-mesenchymal transition and survival factors BMP-7 and Bcl-2 and preserved capillary density in rat cardiac allografts at day 10. In mouse cardiac allografts PDGF receptor-β, but not -α intragraft messenger RNA levels were reduced and capillary protein localization was lost during IRI. The PDGF receptor tyrosine kinase inhibitor imatinib mesylate and a monoclonal antibody against PDGF receptor-α enhanced myocardial damage evidenced by serum cardiac troponin T release in the rat and mouse cardiac allografts 6 hours after reperfusion, respectively. Moreover, imatinib mesylate enhanced rat cardiac allograft vasculopathy, cardiac fibrosis, and late allograft loss at day 56. CONCLUSIONS Our results suggest that PDGF-B signaling may play a role in endothelial and cardiomyocyte recovery from IRI after heart transplantation.
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Erbel C, Mukhammadaminova N, Gleissner CA, Osman NF, Hofmann NP, Steuer C, Akhavanpoor M, Wangler S, Celik S, Doesch AO, Voss A, Buss SJ, Schnabel PA, Katus HA, Korosoglou G. Myocardial Perfusion Reserve and Strain-Encoded CMR for Evaluation of Cardiac Allograft Microvasculopathy. JACC Cardiovasc Imaging 2016; 9:255-66. [DOI: 10.1016/j.jcmg.2015.10.012] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 10/02/2015] [Accepted: 10/07/2015] [Indexed: 10/22/2022]
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Gupta B, Jacob D, Thompson R. Imaging in patients after cardiac transplantation and in patients with ventricular assist devices. J Nucl Cardiol 2015; 22:617-38. [PMID: 25832983 DOI: 10.1007/s12350-015-0115-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 01/29/2015] [Indexed: 02/06/2023]
Abstract
The field of cardiac imaging and the management of patients with severe heart failure have advanced substantially during the past 10 years. Cardiac transplantation offers the best long-term survival with high quality of life for the patients with end stage heart failure. However, acute cardiac rejection and cardiac allograft vasculopathy (CAV) can occur post cardiac transplantation and these problems necessitate regular surveillance. The short-term success of mechanical circulatory support devices (MCSD), such as ventricular assist devices (VADs), in improving survival and quality of life has led to a dramatic growth of the patient population with these devices. The development of optimal imaging techniques and algorithms to evaluate these advanced heart failure patients is evolving and multimodality non-invasive imaging approaches and invasive techniques are commonly employed. Most of the published studies done in the transplant and VAD population are small, and biased based on the strength of the particular program, and there is a relative lack of published protocols to evaluate these patient groups. Moreover, the techniques of echocardiography, computed tomography (CT), magnetic resonance imaging, and nuclear cardiology have all progressed rapidly in recent years. There is thus a knowledge gap for cardiologists, radiologists, and clinicians, especially regarding surveillance for CAV and ideal imaging approaches for patients with VADs. The purpose of this review article is to provide an overview of different noninvasive imaging modalities used to evaluate patients after cardiac transplantation and for patients with VADs. The review focuses on the role of echocardiography, CT, and nuclear imaging in surveillance for CAV and rejection and on the assessment of ventricular structure and function, myocardial remodeling and complications for VAD patients.
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Affiliation(s)
- Bhanu Gupta
- Department of Cardiology, St. Luke's Mid America Heart Institute, 4330 Wornall Rd, Suite 2000, Kansas City, MO, USA
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15
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Skorić B, Čikeš M, Ljubas Maček J, Baričević Ž, Škorak I, Gašparović H, Biočina B, Miličić D. Cardiac allograft vasculopathy: diagnosis, therapy, and prognosis. Croat Med J 2015; 55:562-76. [PMID: 25559827 PMCID: PMC4295072 DOI: 10.3325/cmj.2014.55.562] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Development of cardiac allograft vasculopathy represents the major determinant of long-term survival in patients after heart transplantation. Due to graft denervation, these patients seldom present with classic symptoms of angina pectoris, and the first clinical presentations are progressive heart failure or sudden cardiac death. Although coronary angiography remains the routine technique for coronary artery disease detection, it is not sensitive enough for screening purposes. This is especially the case in the first year after transplantation when diffuse and concentric vascular changes can be easily detected only by intravascular ultrasound. The treatment of the established vasculopathy is disappointing, so the primary effort should be directed toward early prevention and diagnosis. Due to diffuse vascular changes, revascularization procedures are restricted only to a relatively small proportion of patients with favorable coronary anatomy. Percutaneous coronary intervention is preferred over surgical revascularization since it leads to better acute results and patient survival. Although there is no proven long-term advantage of drug-eluting stents for the treatment of in-stent restenosis, they are preferred over bare-metal stents. Severe vasculopathy has a poor prognosis and the only definitive treatment is retransplantation. This article reviews the present knowledge on the pathogenesis, diagnosis, treatment, and prognosis of cardiac allograft vasculopathy.
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Affiliation(s)
- Boško Skorić
- Bosko Skoric, University of Zagreb School of Medicine, Department of Cardiovascular Diseases, University Hospital Center Zagreb, Kispaticeva 12, 10 000 Zagreb, Croatia,
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16
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Dall CH, Gustafsson F, Christensen SB, Dela F, Langberg H, Prescott E. Effect of moderate- versus high-intensity exercise on vascular function, biomarkers and quality of life in heart transplant recipients: A randomized, crossover trial. J Heart Lung Transplant 2015; 34:1033-41. [PMID: 25840503 DOI: 10.1016/j.healun.2015.02.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 01/02/2015] [Accepted: 02/01/2015] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Growing evidence in long-term treatment of heart transplant (HTx) recipients indicates effects of high-intensity interval training (HIIT) on several parameters, including oxygen uptake, vascular function and psychological distress. In this study we compare the effect of HIIT vs continued moderate training (CON) on vascular function, biomarkers and health-related quality of life (HRQoL) in HTx recipients. METHODS A randomized, controlled crossover trial of stable HTx recipients >12 months after transplantation was done on patients with 12 weeks of HIIT or 12 weeks of CON, followed by a 5-month washout and crossover. Outcomes included endothelial function, arterial stiffness, biomarkers, HRQoL and markers of anxiety and depression. RESULTS Sixteen HTx recipients (mean age 52 years, 75% male) completed the study. HIIT increased VO(2peak) more than CON (between-group difference, p < 0.001). The physical component score of the 36-item Short Form (SF-36) was increased significantly in HIIT patients (p = 0.02) and borderline increased in CON patients (p = 0.07), whereas there was no significant effect of exercise on the mental component. Depression score decreased significantly in HIIT patients (p = 0.04) with no change in CON patients (p = 0.75), whereas anxiety score decreased significantly in both HIIT (p < 0.01) and CON (p < 0.05) patients. There were no between-group differences in any of the measures (all p > 0.05). Arterial stiffness and biomarkers were not changed, nor did endothelial function change after HIIT (p = 0.08) or CON (p = 0.68). CONCLUSIONS HIIT and CON are both well tolerated and induce similar improvements in physical components of HRQoL and in markers of anxiety. Effects of either training modality on vascular function and biomarkers could not be confirmed.
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Affiliation(s)
- Christian H Dall
- Department of Cardiology, Bispebjerg Hospital, University of Copenhagen; Institute of Sports Medicine Copenhagen (ISMC/MRRU).
| | - Finn Gustafsson
- Department of Cardiology, Heart Centre, Rigshospitalet, University of Copenhagen
| | | | - Flemming Dela
- Xlab, Center for Healthy Aging, University of Copenhagen
| | - Henning Langberg
- CopenRehab, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Eva Prescott
- Department of Cardiology, Bispebjerg Hospital, University of Copenhagen
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Dedieu N, Greil G, Wong J, Fenton M, Burch M, Hussain T. Diagnosis and management of coronary allograft vasculopathy in children and adolescents. World J Transplant 2014; 4:276-293. [PMID: 25540736 PMCID: PMC4274597 DOI: 10.5500/wjt.v4.i4.276] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Revised: 08/12/2014] [Accepted: 09/17/2014] [Indexed: 02/05/2023] Open
Abstract
Coronary allograft vasculopathy remains one of the leading causes of death beyond the first year post transplant. As a result of denervation following transplantation, patients lack ischaemic symptoms and presentation is often late when the graft is already compromised. Current diagnostic tools are rather invasive, or in case of angiography, significantly lack sensitivity. Therefore a non-invasive tool that could allow early diagnosis would be invaluable.This paper review the disease form its different diagnosis techniques,including new and less invasive diagnostic tools to its pharmacological management and possible treatments.
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Shantsila E, Wrigley BJ, Blann AD, Gill PS, Lip GY. A contemporary view on endothelial function in heart failure. Eur J Heart Fail 2014; 14:873-81. [DOI: 10.1093/eurjhf/hfs066] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Affiliation(s)
- Eduard Shantsila
- University of Birmingham Centre for Cardiovascular Sciences, City Hospital; Birmingham B18 7QH UK
| | - Benjamin J. Wrigley
- University of Birmingham Centre for Cardiovascular Sciences, City Hospital; Birmingham B18 7QH UK
| | - Andrew D. Blann
- University of Birmingham Centre for Cardiovascular Sciences, City Hospital; Birmingham B18 7QH UK
| | - Paramjit S. Gill
- Primary Care Clinical Sciences; University of Birmingham; Birmingham UK
| | - Gregory Y.H. Lip
- University of Birmingham Centre for Cardiovascular Sciences, City Hospital; Birmingham B18 7QH UK
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20
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Miller CA, Sarma J, Naish JH, Yonan N, Williams SG, Shaw SM, Clark D, Pearce K, Stout M, Potluri R, Borg A, Coutts G, Chowdhary S, McCann GP, Parker GJM, Ray SG, Schmitt M. Multiparametric cardiovascular magnetic resonance assessment of cardiac allograft vasculopathy. J Am Coll Cardiol 2013; 63:799-808. [PMID: 24355800 DOI: 10.1016/j.jacc.2013.07.119] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Revised: 06/21/2013] [Accepted: 07/15/2013] [Indexed: 11/17/2022]
Abstract
OBJECTIVES This study sought to evaluate the diagnostic performance of multiparametric cardiovascular magnetic resonance (CMR) for detecting cardiac allograft vasculopathy (CAV) using contemporary invasive epicardial artery and microvascular assessment techniques as reference standards, and to compare the performance of CMR with that of angiography. BACKGROUND CAV continues to limit the long-term survival of heart transplant recipients. Coronary angiography has a Class I recommendation for CAV surveillance and annual or biannual surveillance angiography is performed routinely in most centers. METHODS All transplant recipients referred for surveillance angiography at a single UK center over a 2-year period were prospectively screened for study eligibility. Patients prospectively underwent coronary angiography followed by coronary intravascular ultrasound, fractional flow reserve, and index of microcirculatory resistance. Within 1 month, patients underwent multiparametric CMR, including assessment of regional and global ventricular function, absolute myocardial blood flow quantification, and myocardial tissue characterization. In addition, 10 healthy volunteers underwent CMR. RESULTS Forty-eight patients were recruited, median 7.1 years (interquartile range: 4.6 to 10.3 years) since transplantation. The CMR myocardial perfusion reserve was the only independent predictor of both epicardial (β = -0.57, p < 0.001) and microvascular disease (β = -0.60, p < 0.001) on stepwise multivariable regression. The CMR myocardial perfusion reserve significantly outperformed angiography for detecting moderate CAV (area under the curve, 0.89 [95% confidence interval (CI): 0.79 to 1.00] vs. 0.59 [95% CI: 0.42 to 0.77], p = 0.01) and severe CAV (area under the curve, 0.88 [95% CI: 0.78 to 0.98] vs. 0.67 [95% CI: 0.52 to 0.82], p = 0.05). CONCLUSIONS CAV, including epicardial and microvascular components, can be detected more accurately using noninvasive CMR-based absolute myocardial blood flow assessment than with invasive coronary angiography, the current clinical surveillance technique.
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Affiliation(s)
- Christopher A Miller
- North West Heart Centre and Transplant Centre, University Hospital of South Manchester, Wythenshawe Hospital, Manchester, United Kingdom; Centre for Imaging Sciences and Biomedical Imaging Institute, University of Manchester, Manchester, United Kingdom; Institute of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom.
| | - Jaydeep Sarma
- North West Heart Centre and Transplant Centre, University Hospital of South Manchester, Wythenshawe Hospital, Manchester, United Kingdom; Institute of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
| | - Josephine H Naish
- Centre for Imaging Sciences and Biomedical Imaging Institute, University of Manchester, Manchester, United Kingdom
| | - Nizar Yonan
- North West Heart Centre and Transplant Centre, University Hospital of South Manchester, Wythenshawe Hospital, Manchester, United Kingdom; Institute of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
| | - Simon G Williams
- North West Heart Centre and Transplant Centre, University Hospital of South Manchester, Wythenshawe Hospital, Manchester, United Kingdom; Institute of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
| | - Steven M Shaw
- North West Heart Centre and Transplant Centre, University Hospital of South Manchester, Wythenshawe Hospital, Manchester, United Kingdom; Institute of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
| | - David Clark
- Alliance Medical Cardiac MRI Unit, Wythenshawe Hospital, Manchester, United Kingdom
| | - Keith Pearce
- North West Heart Centre and Transplant Centre, University Hospital of South Manchester, Wythenshawe Hospital, Manchester, United Kingdom
| | - Martin Stout
- North West Heart Centre and Transplant Centre, University Hospital of South Manchester, Wythenshawe Hospital, Manchester, United Kingdom
| | - Rahul Potluri
- North West Heart Centre and Transplant Centre, University Hospital of South Manchester, Wythenshawe Hospital, Manchester, United Kingdom; Centre for Imaging Sciences and Biomedical Imaging Institute, University of Manchester, Manchester, United Kingdom
| | - Alex Borg
- North West Heart Centre and Transplant Centre, University Hospital of South Manchester, Wythenshawe Hospital, Manchester, United Kingdom
| | - Glyn Coutts
- Christie Medical Physics and Engineering, Christie Hospital, Manchester, United Kingdom
| | - Saqib Chowdhary
- North West Heart Centre and Transplant Centre, University Hospital of South Manchester, Wythenshawe Hospital, Manchester, United Kingdom; Institute of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
| | - Gerry P McCann
- NIHR Leicester Cardiovascular Biomedical Research Unit and Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
| | - Geoffrey J M Parker
- Centre for Imaging Sciences and Biomedical Imaging Institute, University of Manchester, Manchester, United Kingdom
| | - Simon G Ray
- North West Heart Centre and Transplant Centre, University Hospital of South Manchester, Wythenshawe Hospital, Manchester, United Kingdom; Institute of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
| | - Matthias Schmitt
- North West Heart Centre and Transplant Centre, University Hospital of South Manchester, Wythenshawe Hospital, Manchester, United Kingdom; Institute of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
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ST-Elevation Myocardial Infarction Following Heart Transplantation as an Unusual Presentation of Coronary Allograft Vasculopathy: A Case Report. Transplant Proc 2013; 45:787-91. [DOI: 10.1016/j.transproceed.2012.08.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Accepted: 08/28/2012] [Indexed: 11/24/2022]
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Flammer AJ, Anderson T, Celermajer DS, Creager MA, Deanfield J, Ganz P, Hamburg NM, Lüscher TF, Shechter M, Taddei S, Vita JA, Lerman A. The assessment of endothelial function: from research into clinical practice. Circulation 2012; 126:753-67. [PMID: 22869857 DOI: 10.1161/circulationaha.112.093245] [Citation(s) in RCA: 827] [Impact Index Per Article: 68.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Andreas J Flammer
- Division of Cardiovascular Diseases, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
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Garrido IP, García-Lara J, Pinar E, Pastor-Pérez F, Sánchez-Mas J, Valdés-Chavarri M, Pascual-Figal DA. Optical coherence tomography and highly sensitivity troponin T for evaluating cardiac allograft vasculopathy. Am J Cardiol 2012; 110:655-61. [PMID: 22640973 DOI: 10.1016/j.amjcard.2012.04.047] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2012] [Revised: 04/26/2012] [Accepted: 04/26/2012] [Indexed: 12/21/2022]
Abstract
Cardiac allograft vasculopathy (CAV) is a major impediment to long-term graft survival after heart transplantation. Intravascular ultrasound (IVUS) is more sensitive than coronary angiography for diagnosis, but the identification of specific plaque components or plaque composition is limited. In addition, there is an evident need for other noninvasive tools for diagnosing CAV. The aim of this study was to assess the utility of 2 new techniques for evaluating CAV: optical coherence tomography (OCT), and new high-sensitivity troponin T (hsTnT) assays. In 21 heart transplantation patients, coronary arteriography with IVUS and OCT were performed. Maximal intimal thickness (MIT) and luminal area at the most severe site were measured using the 2 techniques. Immediately before cardiac catheterization, blood samples were obtained and hsTnT levels measured. The evaluation of CAV by OCT showed a good correlation with IVUS measurements, with a mean difference in MIT of 0.0033 (95% confidence interval -0.049 to 0.043), taking advantage of lower interobserver variability (r = 0.94 for OCT vs r = 0.78 for IVUS) and better plaque characterization. When independent predictors of MIT were assessed in a multiple linear regression model, time after transplantation (β = 0.488, p = 0.004) and hsTnT (β = 0.392, p = 0.011) were the only independent predictors of MIT (R(2) = 0.591). In conclusion, this study is the first to evaluate 2 new techniques, OCT and hsTnT, in the challenging setting of CAV. The findings suggest that OCT provides lower interobserver variability and better plaque characterization than IVUS. Also, hsTnT could become a useful tool for ruling out CAV.
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Affiliation(s)
- Iris P Garrido
- Department of Cardiology, Virgen de la Arrixaca University Hospital, Murcia, Spain.
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Haddad F, Khazanie P, Deuse T, Weisshaar D, Zhou J, Nam CW, Vu TA, Gomari FA, Skhiri M, Simos A, Schnittger I, Vrotvec B, Hunt SA, Fearon WF. Clinical and functional correlates of early microvascular dysfunction after heart transplantation. Circ Heart Fail 2012; 5:759-68. [PMID: 22933526 DOI: 10.1161/circheartfailure.111.962787] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Microvascular dysfunction is emerging as a strong predictor of outcome in heart transplant recipients. At this time, the determinants and consequences of early microvascular dysfunction are not well established. The objective of the study was to determine the risk factors and functional correlates associated with early microvascular dysfunction in heart transplant recipients. METHODS AND RESULTS Sixty-three heart transplant recipients who had coronary physiology assessment, right heart catheterization, and echocardiography performed at the time of their first annual evaluation were included in the study. Microvascular dysfunction was assessed using the recently described index of microcirculatory resistance. The presence of microvascular dysfunction, predefined by an index of microcirculatory resistance >20, was observed in 46% of patients at 1 year. A history of acute rejection and undersized donor hearts were associated with microvascular dysfunction at 1 year, with odds ratio of 4.0 (1.3-12.8) and 3.6 (1.2-11.1), respectively. Patients with microvascular dysfunction had lower cardiac index (3.1±0.7 versus 3.5±0.7 L/min per m(2); P=0.02) and mild graft dysfunction measured by echocardiography-derived left and right myocardial performance indices ([0.54±0.09 versus 0.43±0.09; P<0.01] and [0.47±0.14 versus 0.32±0.05; P<0.01], respectively). Microvascular dysfunction was also associated with a higher likelihood of death, graft failure, or allograft vasculopathy at 5 years after transplant (hazard ratio, 2.52 [95% CI, 1.04-5.91]). CONCLUSIONS A history of acute rejection during the first year and smaller donor hearts were identified as risk factors for early microvascular dysfunction. Microvascular dysfunction assessed using index of microcirculatory resistances at 1 year was also associated with worse graft function and possibly worse clinical outcomes.
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Affiliation(s)
- François Haddad
- Department of Medicine, Stanford University, Stanford, CA, USA.
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Abstract
BACKGROUND The angiographic incidence of coronary dilatation (CD) in the nontransplant population is approximately 0.2% to 5%. The endothelial-dependent and -independent causes for CD are postulated. So far, the incidence and prognosis of CD after heart transplantation is unknown. METHODS We retrospectively analyzed the annual coronary angiographies of 688 heart transplant recipients regarding the incidence of CD (defined as ≥1.5-fold localized increased vessel diameter or diffuse dilatation involving more than 50% of the coronary artery). A subgroup analysis of coronary epicardial (quantitative angiography) and microvascular (doppler flow measurement) vasomotor function in response to acetylcholine (endothelial dependent) and adenosine (endothelial independent) as well as intravascular ultrasound was performed in 177 patients. RESULTS CD was detectable in 26 patients (3.8%) and was associated with stenosing coronary artery disease in 27% of the patients. Segments with CD tended to have less intimal hyperplasia compared with nondilated segments. A diffuse dilatation (type I-II) was present in 63% of the recipients. The right coronary artery was always involved. The patients with CD (5 of 177) showed a 31% reduced flow velocity in the dilated coronaries compared with the nondilated coronary arteries (P=0.03). Microvascular endothelial-independent function was impaired in CD by -29% (coronary flow reserve mean 1.9 vs. 2.7; P=0.04), whereas endothelial-dependent response was unchanged. Epicardial endothelial-dependent and -independent responses were not different between the groups. Incidence of CD was not associated with limited survival. CONCLUSION The incidence of CD in the nontransplant population is similar to that in the transplanted population. However, the latter shows a more diffuse extent. Heart transplantation patients with CD had microvascular endothelial-independent functional limitations and flow deceleration, whereas survival was not affected.
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Takishima I, Nakamura T, Hirano M, Kitta Y, Kobayashi T, Fujioka D, Saito Y, Watanabe K, Watanabe Y, Mishina H, Obata JE, Kawabata KI, Tamaru S, Kugiyama K. Predictive value of serial assessment of endothelial function in chronic heart failure. Int J Cardiol 2011; 158:417-22. [PMID: 21371765 DOI: 10.1016/j.ijcard.2011.01.059] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2010] [Revised: 01/13/2011] [Accepted: 01/23/2011] [Indexed: 01/07/2023]
Abstract
BACKGROUND It remains undefined whether reversibility of endothelial dysfunction after optimized therapies for heart failure (HF) provides prognostic information in patients with HF. This study examined whether changes in endothelial vasomotor function after therapies for HF may predict future outcomes in patients with stable HF. METHODS This study included 245 patients with stable chronic ischemic HF and an impaired flow-mediated dilation (FMD) of the brachial artery (FMD <5.5%). Measurement of FMD was repeated after 6 months for individualized and optimized therapy for HF and atherosclerotic risk factors. Patients were followed for 36 months or until the occurrence of cardiac death or hospitalization with decompensated HF. RESULTS FMD was persistently impaired (<5.5%) in 130 (53%) patients after 6 months of the optimized therapy, whereas it improved (FMD ≥5.5%) in the remaining 115 (47%) patients. During follow-up, an event occurred in 26 (20%) patients with persistently impaired FMD and in 7 (6%) patients with improved FMD (p<0.01). Multivariate Cox hazards analysis showed that persistent impairment of FMD was an independent predictor of cardiac events (hazard ratio 3.0, 95% CI 1.3-6.9, p=0.013). Persistently impaired FMD had a significantly incremental effect on the predictability of brain natriuretic peptide levels for cardiac events. Baseline FMD before the therapy for HF and atherosclerotic risk factors had no significant prognostic information. CONCLUSIONS Persistent endothelial vasomotor dysfunction despite therapies for HF and atherosclerotic risk factors was a predictor of cardiac events in patients with chronic ischemic HF.
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Affiliation(s)
- Isao Takishima
- University of Yamanashi, Faculty of Medicine, Department of Internal Medicine II, Chuo, Yamanashi, Japan
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Hermann TS, Dall CH, Christensen SB, Goetze JP, Prescott E, Gustafsson F. Effect of high intensity exercise on peak oxygen uptake and endothelial function in long-term heart transplant recipients. Am J Transplant 2011; 11:536-41. [PMID: 21219582 DOI: 10.1111/j.1600-6143.2010.03403.x] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Coronary allograft vasculopathy is a well-known long-term complication after cardiac transplantation. Endothelial dysfunction is involved and may be prevented by aerobic exercise. The purpose of this study was to examine whether high intensity aerobic exercise improves peak oxygen uptake (VO(2 peak) ) and endothelial function in heart transplant (HT) recipients. Twenty-seven long-term HT recipients were randomized to either 8-weeks high intensity aerobic exercise or no training. Flow mediated dilation of the brachial artery (FMD) was measured by ultrasound and VO(2 peak) by the analysis of expired air. Blood pressure and biomarkers were measured before and after 8 weeks. VO(2 peak) increased significantly in the exercise group (VO(2 peak) 23.9 ± 1.79 to 28.3 ± 1.63 mL/kg/min compared to controls (VO(2 peak) 24.6 ± 1.38 to 23.4 ± 1.58, p < 0.001 exercise vs. control).FMD increased in the exercise group compared to controls (8.3 ± 1.1% to 11.4 ± 1.2% vs. 5.6 ± 1.0% to 5.3 ± 1.7%, p = 0.024). No increase in nitroglycerin-induced vasodilation was observed. Systolic blood pressure fell in the exercise group (142 ±4.2 mmHg to127 ± 3.4 mmHg, p = 0.01) and was unchanged in controls (141 ± 4.2 mmHg to 142 ±6.4 mmHg, NS). High intensity aerobic exercise reduces systolic blood pressure and improves endothelial function in HT recipients.
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Affiliation(s)
- T S Hermann
- Rigshospitalet, Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark.
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Protective Effect of Mycophenolate Mofetil on Endothelial Function in an Aortic Allograft Model. Transplantation 2011; 91:35-41. [PMID: 21441851 DOI: 10.1097/tp.0b013e3181fe12d6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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The indirect alloimmune response causes microvascular endothelial dysfunction-a possible role for alloantibody. Transplantation 2011; 90:1157-64. [PMID: 21048535 DOI: 10.1097/tp.0b013e3181fa9480] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The causes of endothelial dysfunction after cardiac transplantation are unknown. Here, we have investigated whether the indirect alloimmune response mediates endothelial dysfunction in a major histocompatibility complex class I mismatch model. METHODS PVG.RT1 rat hearts were transplanted into thymectomized CD8 T-cell-depleted allogeneic (PVG.R8) or syngeneic (PVG.RT1) recipients. Alloantibody was assessed at 2, 4, and 8 weeks. Cardiac allograft vasculopathy, the nature of the inflammatory infiltrate, and origin of endothelial cells were examined at 1, 2, 4, and 8 weeks. Endothelial function was assessed by Langendorff preparations at 1, 2, and 4 weeks. RESULTS Recipients produced alloantibody and showed luminal occlusion at 1 (17.7%±8.0%), 2 (23.2%±4.9%), 4 (34.3%±5.0%), and 8 weeks (58.1%±1.8%) posttransplantation. The major inflammatory features of the allografts consisted of CD11b monocytes, CD4 T cells, and C4d deposition. At 1 week, the basal coronary flow and the vasodilator response to 5-hydroxytrytamine of syngeneic and allografted hearts were inhibited compared with normal hearts. At 4 weeks, the basal coronary flow of allografts was 54% lower than syngrafts (P<0.01), and 5- hydroxytrytamine and sodium nitroprusside did not evoke an increase in coronary flow in the allograft heart compared with syngeneic controls (P<0.01). Culture of aortic rings with antibody to major histocompatibility complex class I inhibited endothelium-dependent vasodilation to acetylcholine. CONCLUSION Transient microvascular endothelial dysfunction occurred in syngeneic and allogeneic cardiac grafts after transplantation. Syngeneic but not allogeneic grafts recovered, suggesting the indirect immune response, consisting of CD4 T cells, monocytes, and antibody, mediates endothelial dysfunction. A possible role for alloantibody in endothelial dysfunction is discussed.
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Sjögren J, Ljungdahl-Waller F, Senneby E, Ekmehag B, Koul B, Nilsson J. Heart transplantation with ABO-identical versus ABO-compatible cardiac grafts: Influence on long-term survival. SCAND CARDIOVASC J 2010; 44:373-9. [DOI: 10.3109/14017431.2010.509450] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Mehra MR, Crespo-Leiro MG, Dipchand A, Ensminger SM, Hiemann NE, Kobashigawa JA, Madsen J, Parameshwar J, Starling RC, Uber PA. International Society for Heart and Lung Transplantation working formulation of a standardized nomenclature for cardiac allograft vasculopathy-2010. J Heart Lung Transplant 2010; 29:717-27. [PMID: 20620917 DOI: 10.1016/j.healun.2010.05.017] [Citation(s) in RCA: 640] [Impact Index Per Article: 45.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2010] [Accepted: 05/22/2010] [Indexed: 01/14/2023] Open
Abstract
The development of cardiac allograft vasculopathy remains the Achilles heel of cardiac transplantation. Unfortunately, the definitions of cardiac allograft vasculopathy are diverse, and there are no uniform international standards for the nomenclature of this entity. This consensus document, commissioned by the International Society of Heart and Lung Transplantation Board, is based on best evidence and clinical consensus derived from critical analysis of available information pertaining to angiography, intravascular ultrasound imaging, microvascular function, cardiac allograft histology, circulating immune markers, non-invasive imaging tests, and gene-based and protein-based biomarkers. This document represents a working formulation for an international nomenclature of cardiac allograft vasculopathy, similar to the development of the system for adjudication of cardiac allograft rejection by histology.
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Affiliation(s)
- Mandeep R Mehra
- ISHLT Working Group on Classification of Cardiac Allograft Vasculopathy commissioned by the Education Committee and Board of Directors of the Society.
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Wellnhofer E, Stypmann J, Bara CL, Stadlbauer T, Heidt MC, Kreider-Stempfle HU, Sohn HY, Zeh W, Comberg T, Eckert S, Dengler T, Ensminger SM, Hiemann NE. Angiographic assessment of cardiac allograft vasculopathy: results of a Consensus Conference of the Task Force for Thoracic Organ Transplantation of the German Cardiac Society. Transpl Int 2010; 23:1094-104. [DOI: 10.1111/j.1432-2277.2010.01096.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Spyridopoulos I, Hoffmann J, Aicher A, Brümmendorf TH, Doerr HW, Zeiher AM, Dimmeler S. Accelerated Telomere Shortening in Leukocyte Subpopulations of Patients With Coronary Heart Disease. Circulation 2009; 120:1364-72. [DOI: 10.1161/circulationaha.109.854299] [Citation(s) in RCA: 114] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Shortening of mean telomere length (TL) in white blood cells is correlated with the development of coronary heart disease (CHD) and with increased mortality due to infectious disease. The goal of the present study was to investigate whether telomere shortening in CHD is restricted to specific peripheral blood lymphocyte and/or myeloid cell subpopulations. Results were correlated to TL in CD34
+
hematopoietic peripheral blood stem cells and progenitor cells obtained from the same individual patients.
Methods and Results—
TL was measured by multicolor flow cytometry–fluorescent in situ hybridization in 12 leukocyte subpopulations after immunomagnetic bead sorting. We investigated TL in 14 young (mean age 25 years) and 13 older (mean age 65 years) healthy male volunteers and in 25 age-matched patients with CHD (mean age 65 years). We show that TL in granulocytes and monocytes mirrors TL of CD34
+
peripheral blood stem cells and progenitor cells extremely well (
r
=0.95,
P
<0.0001) in patients and in healthy adults. TL was ≈0.5 kilobases (kb) shorter in leukocytes from patients with CHD than in their age-matched control subjects. This difference was identical for CD34
+
peripheral blood stem cells and progenitor cells, monocytes, granulocytes, B lymphocytes, and CD4
+
T cells, including their memory and naïve subpopulations. Surprisingly, only in cytotoxic CD8
+
T lymphocytes, we found a substantially increased TL deficit of 1.0 kb in CHD patients as opposed to control subjects. Further analysis revealed that TL shortening was particularly pronounced in CD8
+
CD28
−
T cells obtained from cytomegalovirus-seropositive CHD patients, whereas such a difference was not observed in healthy cytomegalovirus-positive as opposed to cytomegalovirus-negative control subjects. Finally, TL shortening of CD8
+
CD45
RA+
T cells was correlated with the decrease in left ventricular function in CHD patients (
r
=0.629,
P
=0.001).
Conclusions—
Telomere shortening in patients with CHD could potentially be attributed to either inherited TL shortening or acquired accelerated telomere shortening restricted to the hematopoietic system, which affects the baseline TL of all peripheral blood cell populations, including peripheral blood stem cells and progenitor cells. In addition, cytomegalovirus-seropositive patients but not healthy control subjects exhibited further shortening of their cytotoxic T lymphocytes. Surprisingly, TL shortening of CD8
+
T lymphocytes in CHD patients demonstrated a very strong correlation with cardiac dysfunction, which suggests a mechanistic link between CHD and immunosenescence.
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Affiliation(s)
- Ioakim Spyridopoulos
- From the Departments of Cardiology and Institute for Cardiovascular Regeneration, Centre of Molecular Medicine (I.S., J.H., A.A., A.M.Z., S.D.) and Institute of Medical Virology (H.W.D.), Johann Wolfgang Goethe University of Frankfurt, Frankfurt, Germany; Department of Oncology and Hematology (T.H.B.), University Cancer Center Hamburg-Eppendorf, Hamburg, Germany; Department of Hematology and Oncology (T.H.B.), University Hospital Aachen, Aachen, Germany; and Institute of Human Genetics (I.S.),
| | - Jedrzej Hoffmann
- From the Departments of Cardiology and Institute for Cardiovascular Regeneration, Centre of Molecular Medicine (I.S., J.H., A.A., A.M.Z., S.D.) and Institute of Medical Virology (H.W.D.), Johann Wolfgang Goethe University of Frankfurt, Frankfurt, Germany; Department of Oncology and Hematology (T.H.B.), University Cancer Center Hamburg-Eppendorf, Hamburg, Germany; Department of Hematology and Oncology (T.H.B.), University Hospital Aachen, Aachen, Germany; and Institute of Human Genetics (I.S.),
| | - Alexandra Aicher
- From the Departments of Cardiology and Institute for Cardiovascular Regeneration, Centre of Molecular Medicine (I.S., J.H., A.A., A.M.Z., S.D.) and Institute of Medical Virology (H.W.D.), Johann Wolfgang Goethe University of Frankfurt, Frankfurt, Germany; Department of Oncology and Hematology (T.H.B.), University Cancer Center Hamburg-Eppendorf, Hamburg, Germany; Department of Hematology and Oncology (T.H.B.), University Hospital Aachen, Aachen, Germany; and Institute of Human Genetics (I.S.),
| | - Tim H. Brümmendorf
- From the Departments of Cardiology and Institute for Cardiovascular Regeneration, Centre of Molecular Medicine (I.S., J.H., A.A., A.M.Z., S.D.) and Institute of Medical Virology (H.W.D.), Johann Wolfgang Goethe University of Frankfurt, Frankfurt, Germany; Department of Oncology and Hematology (T.H.B.), University Cancer Center Hamburg-Eppendorf, Hamburg, Germany; Department of Hematology and Oncology (T.H.B.), University Hospital Aachen, Aachen, Germany; and Institute of Human Genetics (I.S.),
| | - Hans W. Doerr
- From the Departments of Cardiology and Institute for Cardiovascular Regeneration, Centre of Molecular Medicine (I.S., J.H., A.A., A.M.Z., S.D.) and Institute of Medical Virology (H.W.D.), Johann Wolfgang Goethe University of Frankfurt, Frankfurt, Germany; Department of Oncology and Hematology (T.H.B.), University Cancer Center Hamburg-Eppendorf, Hamburg, Germany; Department of Hematology and Oncology (T.H.B.), University Hospital Aachen, Aachen, Germany; and Institute of Human Genetics (I.S.),
| | - Andreas M. Zeiher
- From the Departments of Cardiology and Institute for Cardiovascular Regeneration, Centre of Molecular Medicine (I.S., J.H., A.A., A.M.Z., S.D.) and Institute of Medical Virology (H.W.D.), Johann Wolfgang Goethe University of Frankfurt, Frankfurt, Germany; Department of Oncology and Hematology (T.H.B.), University Cancer Center Hamburg-Eppendorf, Hamburg, Germany; Department of Hematology and Oncology (T.H.B.), University Hospital Aachen, Aachen, Germany; and Institute of Human Genetics (I.S.),
| | - Stefanie Dimmeler
- From the Departments of Cardiology and Institute for Cardiovascular Regeneration, Centre of Molecular Medicine (I.S., J.H., A.A., A.M.Z., S.D.) and Institute of Medical Virology (H.W.D.), Johann Wolfgang Goethe University of Frankfurt, Frankfurt, Germany; Department of Oncology and Hematology (T.H.B.), University Cancer Center Hamburg-Eppendorf, Hamburg, Germany; Department of Hematology and Oncology (T.H.B.), University Hospital Aachen, Aachen, Germany; and Institute of Human Genetics (I.S.),
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Ahmadi N, Usman N, Shim J, Nuguri V, Vasinrapee P, Hajsadeghi F, Wang Z, Foster GP, Nasir K, Hecht H, Naghavi M, Budoff M. Vascular dysfunction measured by fingertip thermal monitoring is associated with the extent of myocardial perfusion defect. J Nucl Cardiol 2009; 16:431-9. [PMID: 19125310 DOI: 10.1007/s12350-008-9044-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2008] [Revised: 12/02/2008] [Accepted: 12/07/2008] [Indexed: 11/24/2022]
Abstract
BACKGROUND Previous studies have shown that vascular dysfunction measured by digital thermal monitoring (DTM) during an arm-cuff reactive hyperemia procedure correlates with the severity of coronary artery disease measured by coronary artery calcium in asymptomatic patients. Current study investigates the correlation between DTM and abnormal myocardial perfusion imaging (MPI). METHODS About 116 consecutive patients with chest discomfort, age 57 +/- 10 years, underwent MPI, DTM and Framingham Risk Score (FRS) assessment. Fingertip temperature rebound (TR), DTM index of vascular reactivity, was assessed after a 2-minute arm-cuff reactive hyperemia test. The extent of myocardial perfusion defect was measured by summed stress score (SSS). RESULTS TR decreased from SSS < 4 (1.61 +/- 0.15) to 4 < or = SSS < or = 8 (0.5 +/- 0.22) to 9 < or = SSS < or = 13 (0.26 +/- 0.15) to SSS > 13 (-0.37 +/- 0.19) (P = .0001). After adjusting for cardiac risk factors, the odds ratio of the lowest versus two upper tertiles of TR was 3.93 for SSS > or = 4 and 9.65 for SSS > or = 8 compared to SSS < 4. TR correlated well with SSS (r = -0.88, P = .0001). Addition of TR to FRS increased the area under the ROC curve to predict abnormal MPI, SSS > or = 4, from 0.65 to 0.84 (P < .05). CONCLUSION Vascular dysfunction measured by DTM is associated with the extent of myocardial perfusion defect independent of age, gender, and cardiac risk factors.
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Affiliation(s)
- Naser Ahmadi
- Los Angeles Biomedical Research Institute, Harbor UCLA Medical Center, 1124 W. Carson Street, RB2, Torrance, CA 90502, USA
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Tsai VW, Cooper J, Garan H, Natale A, Ptaszek LM, Ellinor PT, Hickey K, Downey R, Zei P, Hsia H, Wang P, Hunt S, Haddad F, Al-Ahmad A. The Efficacy of Implantable Cardioverter-Defibrillators in Heart Transplant Recipients. Circ Heart Fail 2009; 2:197-201. [DOI: 10.1161/circheartfailure.108.814525] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Sudden cardiac death among orthotopic heart transplant recipients is an important mechanism of death after cardiac transplantation. The role for implantable cardioverter-defibrillators (ICDs) in this population is not well established. This study sought to determine whether ICDs are effective in preventing Sudden cardiac death in high-risk heart transplant recipients.
Methods and Results—
We retrospectively analyzed the records of all orthotopic heart transplant patients who had ICD implantation between January 1995 and December 2005 at 5 heart transplant centers. Thirty-six patients were considered high risk for sudden cardiac death. The mean age at orthotopic heart transplant was 44�14 years, the majority being male (n=29). The mean age at ICD implantation was 52�14 years, whereas the average time from orthotopic heart transplant to ICD implant was 8 years �6 years. The main indications for ICD implantation were severe allograft vasculopathy (n=12), unexplained syncope (n=9), history of cardiac arrest (n=8), and severe left ventricular dysfunction (n=7). Twenty-two shocks were delivered to 10 patients (28%), of whom 8 (80%) received 12 appropriate shocks for either rapid ventricular tachycardia or ventricular fibrillation. The shocks were effective in terminating the ventricular arrhythmias in all cases. Three (8%) patients received 10 inappropriate shocks. Underlying allograft vasculopathy was present in 100% (8 of 8) of patients who received appropriate ICD therapy.
Conclusions—
Use of ICDs after heart transplantation may be appropriate in selected high-risk patients. Further studies are needed to establish an appropriate prevention strategy in this population.
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Affiliation(s)
- Vivian W. Tsai
- From the Division of Cardiovascular Medicine (V.W.T., P.Z., H.H., P.W., S.H., F.H., A.A.L.), Stanford University, Stanford, Calif; Division of Cardiology (J.C.), University of Pennsylvania, Philadelphia, Pa; Division of Cardiology (H.G., K.H.), Columbia University, NY; Division of Cardiology (L.M.P., P.T.E.), Arrhythmia Service (P.T.E.), Massachusetts General Hospital, Boston, Mass; The Cleveland Clinic Foundation (R.D.), Cleveland, Ohio; and St. David’s Medical Center (A.N.), Austin, Tex
| | - Joshua Cooper
- From the Division of Cardiovascular Medicine (V.W.T., P.Z., H.H., P.W., S.H., F.H., A.A.L.), Stanford University, Stanford, Calif; Division of Cardiology (J.C.), University of Pennsylvania, Philadelphia, Pa; Division of Cardiology (H.G., K.H.), Columbia University, NY; Division of Cardiology (L.M.P., P.T.E.), Arrhythmia Service (P.T.E.), Massachusetts General Hospital, Boston, Mass; The Cleveland Clinic Foundation (R.D.), Cleveland, Ohio; and St. David’s Medical Center (A.N.), Austin, Tex
| | - Hasan Garan
- From the Division of Cardiovascular Medicine (V.W.T., P.Z., H.H., P.W., S.H., F.H., A.A.L.), Stanford University, Stanford, Calif; Division of Cardiology (J.C.), University of Pennsylvania, Philadelphia, Pa; Division of Cardiology (H.G., K.H.), Columbia University, NY; Division of Cardiology (L.M.P., P.T.E.), Arrhythmia Service (P.T.E.), Massachusetts General Hospital, Boston, Mass; The Cleveland Clinic Foundation (R.D.), Cleveland, Ohio; and St. David’s Medical Center (A.N.), Austin, Tex
| | - Andrea Natale
- From the Division of Cardiovascular Medicine (V.W.T., P.Z., H.H., P.W., S.H., F.H., A.A.L.), Stanford University, Stanford, Calif; Division of Cardiology (J.C.), University of Pennsylvania, Philadelphia, Pa; Division of Cardiology (H.G., K.H.), Columbia University, NY; Division of Cardiology (L.M.P., P.T.E.), Arrhythmia Service (P.T.E.), Massachusetts General Hospital, Boston, Mass; The Cleveland Clinic Foundation (R.D.), Cleveland, Ohio; and St. David’s Medical Center (A.N.), Austin, Tex
| | - Leon M. Ptaszek
- From the Division of Cardiovascular Medicine (V.W.T., P.Z., H.H., P.W., S.H., F.H., A.A.L.), Stanford University, Stanford, Calif; Division of Cardiology (J.C.), University of Pennsylvania, Philadelphia, Pa; Division of Cardiology (H.G., K.H.), Columbia University, NY; Division of Cardiology (L.M.P., P.T.E.), Arrhythmia Service (P.T.E.), Massachusetts General Hospital, Boston, Mass; The Cleveland Clinic Foundation (R.D.), Cleveland, Ohio; and St. David’s Medical Center (A.N.), Austin, Tex
| | - Patrick T. Ellinor
- From the Division of Cardiovascular Medicine (V.W.T., P.Z., H.H., P.W., S.H., F.H., A.A.L.), Stanford University, Stanford, Calif; Division of Cardiology (J.C.), University of Pennsylvania, Philadelphia, Pa; Division of Cardiology (H.G., K.H.), Columbia University, NY; Division of Cardiology (L.M.P., P.T.E.), Arrhythmia Service (P.T.E.), Massachusetts General Hospital, Boston, Mass; The Cleveland Clinic Foundation (R.D.), Cleveland, Ohio; and St. David’s Medical Center (A.N.), Austin, Tex
| | - Kathleen Hickey
- From the Division of Cardiovascular Medicine (V.W.T., P.Z., H.H., P.W., S.H., F.H., A.A.L.), Stanford University, Stanford, Calif; Division of Cardiology (J.C.), University of Pennsylvania, Philadelphia, Pa; Division of Cardiology (H.G., K.H.), Columbia University, NY; Division of Cardiology (L.M.P., P.T.E.), Arrhythmia Service (P.T.E.), Massachusetts General Hospital, Boston, Mass; The Cleveland Clinic Foundation (R.D.), Cleveland, Ohio; and St. David’s Medical Center (A.N.), Austin, Tex
| | - Ross Downey
- From the Division of Cardiovascular Medicine (V.W.T., P.Z., H.H., P.W., S.H., F.H., A.A.L.), Stanford University, Stanford, Calif; Division of Cardiology (J.C.), University of Pennsylvania, Philadelphia, Pa; Division of Cardiology (H.G., K.H.), Columbia University, NY; Division of Cardiology (L.M.P., P.T.E.), Arrhythmia Service (P.T.E.), Massachusetts General Hospital, Boston, Mass; The Cleveland Clinic Foundation (R.D.), Cleveland, Ohio; and St. David’s Medical Center (A.N.), Austin, Tex
| | - Paul Zei
- From the Division of Cardiovascular Medicine (V.W.T., P.Z., H.H., P.W., S.H., F.H., A.A.L.), Stanford University, Stanford, Calif; Division of Cardiology (J.C.), University of Pennsylvania, Philadelphia, Pa; Division of Cardiology (H.G., K.H.), Columbia University, NY; Division of Cardiology (L.M.P., P.T.E.), Arrhythmia Service (P.T.E.), Massachusetts General Hospital, Boston, Mass; The Cleveland Clinic Foundation (R.D.), Cleveland, Ohio; and St. David’s Medical Center (A.N.), Austin, Tex
| | - Henry Hsia
- From the Division of Cardiovascular Medicine (V.W.T., P.Z., H.H., P.W., S.H., F.H., A.A.L.), Stanford University, Stanford, Calif; Division of Cardiology (J.C.), University of Pennsylvania, Philadelphia, Pa; Division of Cardiology (H.G., K.H.), Columbia University, NY; Division of Cardiology (L.M.P., P.T.E.), Arrhythmia Service (P.T.E.), Massachusetts General Hospital, Boston, Mass; The Cleveland Clinic Foundation (R.D.), Cleveland, Ohio; and St. David’s Medical Center (A.N.), Austin, Tex
| | - Paul Wang
- From the Division of Cardiovascular Medicine (V.W.T., P.Z., H.H., P.W., S.H., F.H., A.A.L.), Stanford University, Stanford, Calif; Division of Cardiology (J.C.), University of Pennsylvania, Philadelphia, Pa; Division of Cardiology (H.G., K.H.), Columbia University, NY; Division of Cardiology (L.M.P., P.T.E.), Arrhythmia Service (P.T.E.), Massachusetts General Hospital, Boston, Mass; The Cleveland Clinic Foundation (R.D.), Cleveland, Ohio; and St. David’s Medical Center (A.N.), Austin, Tex
| | - Sharon Hunt
- From the Division of Cardiovascular Medicine (V.W.T., P.Z., H.H., P.W., S.H., F.H., A.A.L.), Stanford University, Stanford, Calif; Division of Cardiology (J.C.), University of Pennsylvania, Philadelphia, Pa; Division of Cardiology (H.G., K.H.), Columbia University, NY; Division of Cardiology (L.M.P., P.T.E.), Arrhythmia Service (P.T.E.), Massachusetts General Hospital, Boston, Mass; The Cleveland Clinic Foundation (R.D.), Cleveland, Ohio; and St. David’s Medical Center (A.N.), Austin, Tex
| | - François Haddad
- From the Division of Cardiovascular Medicine (V.W.T., P.Z., H.H., P.W., S.H., F.H., A.A.L.), Stanford University, Stanford, Calif; Division of Cardiology (J.C.), University of Pennsylvania, Philadelphia, Pa; Division of Cardiology (H.G., K.H.), Columbia University, NY; Division of Cardiology (L.M.P., P.T.E.), Arrhythmia Service (P.T.E.), Massachusetts General Hospital, Boston, Mass; The Cleveland Clinic Foundation (R.D.), Cleveland, Ohio; and St. David’s Medical Center (A.N.), Austin, Tex
| | - Amin Al-Ahmad
- From the Division of Cardiovascular Medicine (V.W.T., P.Z., H.H., P.W., S.H., F.H., A.A.L.), Stanford University, Stanford, Calif; Division of Cardiology (J.C.), University of Pennsylvania, Philadelphia, Pa; Division of Cardiology (H.G., K.H.), Columbia University, NY; Division of Cardiology (L.M.P., P.T.E.), Arrhythmia Service (P.T.E.), Massachusetts General Hospital, Boston, Mass; The Cleveland Clinic Foundation (R.D.), Cleveland, Ohio; and St. David’s Medical Center (A.N.), Austin, Tex
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Shechter M, Matetzky S, Arad M, Feinberg MS, Freimark D. Vascular endothelial function predicts mortality risk in patients with advanced ischaemic chronic heart failure. Eur J Heart Fail 2009; 11:588-93. [PMID: 19406838 DOI: 10.1093/eurjhf/hfp053] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIMS Endothelial function is impaired in advanced chronic heart failure (ACHF) patients. We explored a possible association between endothelial function and subsequent mortality risk in ACHF. METHODS AND RESULTS We prospectively assessed brachial flow-mediated dilation (FMD) in 82 consecutive New York Heart Association class IV ischaemic ACHF patients with a mean left ventricular ejection fraction (LVEF) of 22 +/- 3%. Following overnight fasting and discontinuation of all medications for > or = 12 h, percent increase in FMD (%FMD) and nitroglycerin-mediated vasodilation were assessed using linear array ultrasound. All patients were followed for 14 +/- 2 months for adverse cardiovascular events, including death, hospitalization for CHF exacerbation, or myocardial infarction. Patients were divided into two groups: those with an FMD lesser than or equal to the median %FMD of 4.6% (n = 41) and those with an FMD above the median (n = 41). Both groups were comparable regarding cardiovascular risk factors, LVEF, and concomitant medications. During follow-up, 22 (53.6%) patients with FMD lesser than or equal to the median had composite adverse cardiovascular events compared with only eight patients (19.5%) with FMD above the median (P < 0.01). Furthermore, fiver deaths (12.1%) occurred in patients with FMD lesser than or equal to the median, compared with no deaths in patients with FMD above the median (P < 0.03). Cox regression analyses revealed that FMD was an independent predictor for these events. CONCLUSION Flow-mediated dilation is associated with increased mortality risk in ischaemic ACHF patients.
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Affiliation(s)
- Michael Shechter
- Heart Institute, Chaim Sheba Medical Center, 52621 Tel Hashomer, Israel.
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