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Elevated immune monitoring early after cardiac transplantation is associated with increased plaque progression by intravascular ultrasound
Author(s) -
Cheng Richard,
Azarbal Babak,
Yung Aaron,
Chang David H.,
Patel Jignesh K.,
Kobashigawa Jon A.
Publication year - 2015
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.12489
Subject(s) - medicine , intravascular ultrasound , quartile , cardiology , heart transplantation , stenosis , cardiac allograft vasculopathy , transplantation , cutoff , urology , gastroenterology , confidence interval , physics , quantum mechanics
Background Immune monitoring ( IM ) has not been shown to be associated with cardiac allograft vasculopathy ( CAV ). Methods Maximal intimal area, average percent stenosis, plaque volume, and maximal intimal thickness ( MIT ) were measured for matched baseline and one‐yr IVUS segments in a blinded fashion. Patients were divided into quartiles by IM scores and outcomes compared. Optimal IM cutoff was determined. Results IM assays were measured at 63.7 ± 16.4 d after transplantation in fifty patients. Progression of maximal intimal area (p = 0.005), average percent stenosis (p < 0.001), plaque volume (p = 0.005), and MIT (p = 0.001) were increased across the quartiles. An optimal IM assay cutoff of 406.0 ng ATP /mL demonstrated a sensitivity of 66.7% and specificity of 94.3% for predicting rapid progression of MIT ≥ 0.5 mm. Mean IM scores for Group 1 vs. Group 2 were 176.4 ± 102.2 and 616.3 ± 239.5 ng ATP /mL, respectively. Rapid progression of MIT ≥ 0.5 mm occurred in 5/38 patients (13.2%) in Group 1 vs. 10/12 patients (83.3%) in Group 2 (p < 0.001). The risk ratio for rapid progression with elevated IM was 11.7 (p < 0.001). Conclusion Elevated early IM scores are associated with progression of CAV by IVUS . These findings suggest the potential of IM for tailoring of immunosuppressive regimens to minimize the progression of CAV in high‐risk patients.