PREDICTION OF ANGIOGRAPHIC DISEASE BY INTRACORONARY ULTRASONOGRAPHIC FINDINGS IN HEART-TRANSPLANT RECIPIENTS

Citation
Dh. Liang et al., PREDICTION OF ANGIOGRAPHIC DISEASE BY INTRACORONARY ULTRASONOGRAPHIC FINDINGS IN HEART-TRANSPLANT RECIPIENTS, The Journal of heart and lung transplantation, 15(10), 1996, pp. 980-987
Citations number
19
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Cardiac & Cardiovascular System",Transplantation
ISSN journal
1053-2498
Volume
15
Issue
10
Year of publication
1996
Pages
980 - 987
Database
ISI
SICI code
1053-2498(1996)15:10<980:POADBI>2.0.ZU;2-M
Abstract
Background: Intracoronary ultrasonography has proven to be a more sens itive test than angiography for the detection of intimal thickening in transplant recipients. However, the prognostic significance of the in timal thickening detected by intracoronary ultrasonography has not bee n proven. Methods: During a 1-year period, 70 transplant recipients wi thout angiographically apparent coronary artery disease underwent intr acoronary ultrasonography examination. For each intracoronary ultrason ography study an intimal index, defined as the ratio of the plaque are a to the area within the media, was measured for the most diseased seg ment imaged. The subsequent annual follow-up angiograms of these 70 pa tients were reviewed for the development of visually apparent coronary artery disease. The time since transplantation for the 70 patients wi thout angiographically apparent coronary artery disease ranged from 1 to 15 years, with a mean of 4.2 years and median of 3.9 years. Mean du ration of angiographic follow-up was 2.0 years (range 1 to 3 years). R esults: Angiographically apparent coronary artery disease developed on follow-up angiograms in 13 of the 70 patients, with a mean time to de velopment of 1.5 years. Four of 46 patients (9%) with an intimal index <0.3 subsequently had angiographically apparent coronary artery disea se, whereas of 25 patients (36%) with an intimal index greater than or equal to 0.3 subsequently had angiographically apparent coronary arte ry disease. Odds ratio for future angiographically apparent coronary a rtery disease between patients with an intimal index greater than or e qual to 0.3 and intimal index <0.3 was 5.9 (p < 0.01 by Fisher's Exact test). In a subgroup of 22 patients more than 5 years after transplan tation at the time of intracoronary ultrasonography, 12 had an intimal index <0.3 and 10 had an intimal index greater than or equal to 0.3. In this subgroup none of the 12 patients with an intimal index <0.3 ha d angiographically apparent coronary artery disease and only 1 of the 10 with an intimal index greater than or equal to 0.3 had angiographic ally apparent coronary artery disease (difference not significant). Co nclusions: The presence of moderate to severe intimal thickening by in tracoronary ultrasonography is predictive of the future development of angiographically apparent coronary artery disease among patients more than 1 year and less than 5 years after transplantation. This same de gree of intimal thickening may not carry the same prognostic significa nce among patients greater than 5 years after transplantation without the development of angiographically apparent coronary artery disease.