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Intravascular ultrasound–guided selection for early noninvasive cardiac allograft vasculopathy screening in heart transplant recipients
Author(s) -
Nelson Lærke Marie,
Rossing Kasper,
Ihlemann Nikolaj,
Boesgaard Søren,
Engstrøm Thomas,
Gustafsson Finn
Publication year - 2020
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.14124
Subject(s) - medicine , intravascular ultrasound , cardiac allograft vasculopathy , heart transplantation , cardiology , single center , transplantation , surrogate endpoint , risk stratification , angiography
Background Noninvasive screening for cardiac allograft vasculopathy (CAV) instead of invasive coronary angiography (ICA) within the first 3 to 5 years after heart transplantation (HTx) is controversial. We evaluated a strategy of intravascular ultrasound (IVUS)–guided conversion to early noninvasive screening post‐HTx. Methods A single‐center study of 103 consecutive HTx recipients from 2008 to 2018 undergoing ICA at 1 year post‐HTx. Of 88 patients with normal 1‐year ICA, sixty‐six patients underwent IVUS examination for risk stratification by maximal intimal thickness (MIT) into (i) low‐risk group (MIT < 0.5 mm) ( n = 41, 62%) followed noninvasively versus (ii) high‐risk group (MIT ≥ 0.5 mm) ( n = 25, 38%) followed with yearly ICA. Both groups underwent ICA at year 5 post‐HTx. We evaluated a combined endpoint of angiographic CAV and death at 5‐year follow‐up post‐HTx. Results Median (IQR) age was 51 (33–60) years, and 62% were male. Follow‐up was 1443 (1125–1456) days. Survival free from angiographic CAV (Kaplan‐Meier) differed significantly between groups (log‐rank p < .0001). A subgroup of 27 patients completed ICA at year 5, and the proportion of angiographic CAV was significantly lower in low‐risk patients ( p < .0001). Conclusion IVUS‐guided selection for early noninvasive CAV screening appears to be safe and holds promise as a novel strategy for early risk stratification and CAV surveillance post‐HTx.