Attenuated-signal Plaque Progression Predicts Long-term Mortality after Heart Transplantation

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In patients who had heart transplantation, attenuated-signal plaque progression may be an independent predictor of long-term mortality, researchers reported in the Journal of the American College of Cardiology. According to the study background, previous research on coronary atherosclerosis found associations between attenuated-signal plaque, plaque instability and adverse events.

Kozo Okada, MD, from the division of cardiovascular medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, and colleagues enrolled 105 patients who had survived at least 1 year after heart transplantation and had preserved renal function between 2002 and 2013. All patients underwent Intravascular Ultrasound (IVUS) at baseline and at 1 year to determine attenuated-signal plaque progression. The primary endpoint was all-cause death or retransplantation.

During a median follow-up of 4.6 years, 19 patients died and one patient had to be retransplanted. Of the 19 deaths, 12 were cardiac-related and one was due to acute cellular rejection. Twenty-seven percent of all the patients experienced one or more episodes of significant acute cellular rejection during the first year.

IVUS changes:

Patients who experienced all-cause death or retransplantation had greater loss of vessel (P < .05 for interaction) and lumen volume (P < .01 for interaction) than those who did not experience all-cause death or retransplantation.

Overall, 10.5% of patients had attenuated-signal plaque progression 1 year after transplant, and compared with those who did not have it, they were more likely to have acute cellular rejection at 1 year (63.6% vs. 22.3%; P = .006) and had greater intimal growth as measured by percent intimal volume (9.2% vs. 4.4%; P = .07), according to the researchers.

In addition, patients with significant acute cellular rejection at 1 year had greater increases in intimal volume (P = .008), maximal intimal thickness (P = .048) and percent intimal volume (7.3 compared with patients who did not experience acute cellular rejection.

Okada and colleagues reported that 16 patients had attenuated-signal plaque progression at baseline and six new patients developed it by 1-year follow-up. Patients with newly developed attenuated-signal plaque progression all died after follow-up IVUS. Those with attenuated-signal plaque progression at 1 year were at greatly elevated risk for death or retransplantation during the study period (HR = 4.64; 95% CI, 1.72-11.64), the researchers found.

“Serial IVUS assessment of plaque instability in [cardiac allograft vasculopathy] early after transplantation may add incremental prognostic value to the standard assessment of intimal thickening and pathological arterial remodeling, enhancing the identification of high-risk patients who may benefit from closer follow-up and targeted medical therapies,” Okada and colleagues wrote.

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