Clinical heart transplantationDeterminants of Coronary Flow Reserve in Heart Transplantation: A Study Performed With Contrast-enhanced Echocardiography
Section snippets
Study Patients
We studied 119 consecutive HT recipients (97 men, 22 women; median age 55 years at HT, range 9 to 73 years). Median post-HT follow-up at study entry was 8.5 years (range 13 months to 19 years). Our immunosuppression protocol consisted of cyclosporine, azathioprine and steroids (triple therapy), as previously detailed.2, 8 Cytomegalovirus (CMV) serostatus (IgG-positive or IgG-negative) of all donors and recipients was analyzed before HT. The study was approved by the institutional ethics
Baseline Clinical and Diagnostic Features
The baseline features of recipients and donors are shown in Table 1. Echocardiographic regional wall motion abnormalities were not detected. Age and time from HT were comparable in patients with and without abnormal angiography (49 ± 11 vs 51 ± 13 years [p = 0.5] and 8 ± 3 vs 7 ± 3 years [p = 0.4], respectively). Ejection fraction was normal in all patients (73 ± 8%). All patients studied were maintained on a cyclosporine (95%) or tacrolimus (5%) and azathioprine (70%) or mycophenolate
Discussion
This study demonstrates, for the first time, that rejection score is an independent determinant of CFR in HT patients. In addition, recognized determinants of CFR have been confirmed.7
CAV is a diffuse process involving the entire coronary circulation, including microvessels.2 In the present study, CFR impairment in patients with CAV may have been related by hemodynamically significant LAD stenosis. Indeed, it has been shown in several studies that endothelium-dependent and -independent CFR is
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Cited by (23)
Non-invasive Imaging in the Evaluation of Cardiac Allograft Vasculopathy in Heart Transplantation: A Systematic Review
2022, Current Problems in CardiologyCitation Excerpt :There were 30 studies identified for TTE, 24 studies for CT, 14 for MRI and 13 for PET (Consort Diagram). Among the 30 studies that examined TTE as a non-invasive method to detect CAV, 16 studies were included in this study (Table 1)8-23 and examined 1364 patients from 1996-2020. The remaining studies did not contain accessible data.
Imaging of Cardiac Transplantation: An Overview
2021, Seminars in Nuclear MedicineCitation Excerpt :Recent studies suggest that regadenoson is safer than adenosine in HTx patients.65,69-71 Non-invasive CFVR by Doppler echocardiography for CAV diagnosis has been evaluated in several studies 72-74 (Fig. 4 B-D). Tona F et al evaluated the diagnostic value of CFVR by Doppler echocardiography to detect early CAV by IVUS defined as MIT > 0.5 mm in 22 HTx patients.
Early invasive assessment of the coronary microcirculation predicts subsequent acute rejection after heart transplantation
2019, International Journal of CardiologyCitation Excerpt :Indeed, previous studies support this explanation showing that microvascular dysfunction often occurs in the absence of epicardial disease [13,15,16]. Others have shown that episodes of rejection are associated with microvascular dysfunction before the development of significant epicardial CAV [7]. Interstitial edema may also play an important role in the interaction between early changes in AAR and microvascular dysfunction [12].
Noninvasive Detection of Cardiac Allograft Vasculopathy by Stress Exercise Echocardiographic Assessment of Myocardial Deformation
2016, Journal of the American Society of EchocardiographyCitation Excerpt :However, the safety of adenosine in HTX patients is debatable. Infusion of adenosine for 2 min during Doppler assessment of echocardiographic CFVR has been reported to be safe,5-7 whereas an increased risk for atrioventricular and sinus blocks has been reported during single-photon emission computed tomographic scans.31-33 In our study, we found both the 2-min and the 8-min infusions of adenosine to be safe.
Diagnosis, prevention and treatment of cardiac allograft vasculopathy
2012, Revista Portuguesa de Cardiologia