Peripheral microvascular dysfunction is associated with plaque progression and adverse long‐term outcomes in heart transplant patients
Abstract Aims Cardiac allograft vasculopathy (CAV) is the major cause of increased morbidity and mortality after heart transplantation. Peripheral endothelial dysfunction (PED) is associated with early atherosclerosis and future risk of major adverse cardiovascular events (MACE) in non‐heart transpl...
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2021-12-01
|
| Series: | ESC Heart Failure |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/ehf2.13610 |
| _version_ | 1811247753243656192 |
|---|---|
| author | Ilke Ozcan Takumi Toya Michel T. Corban Ali Ahmad Lilach O. Lerman Sudhir S. Kushwaha Amir Lerman |
| author_facet | Ilke Ozcan Takumi Toya Michel T. Corban Ali Ahmad Lilach O. Lerman Sudhir S. Kushwaha Amir Lerman |
| author_sort | Ilke Ozcan |
| collection | DOAJ |
| description | Abstract Aims Cardiac allograft vasculopathy (CAV) is the major cause of increased morbidity and mortality after heart transplantation. Peripheral endothelial dysfunction (PED) is associated with early atherosclerosis and future risk of major adverse cardiovascular events (MACE) in non‐heart transplant population. We aimed to investigate the association of PED with future MACE, and plaque progression assessed by intravascular ultrasound (IVUS) after heart transplantation. Methods and results We included 66 transplant patients who underwent serial IVUS surveillance for CAV and baseline assessment of peripheral endothelial function using reactive hyperaemia peripheral arterial tonometry. PED was defined as reactive hyperaemia index < 2. The primary endpoint of the study was to investigate the association of PED with CAV progression assessed by intravascular ultrasound (IVUS). CAV progression was assessed as the change (Δ) in plaque volume divided by segment length, and Δ plaque index (plaque volume/vessel volume), adjusted for the time between IVUS measurements (median 3.0 [2.2, 3.1] years). The secondary endpoint was to investigate the association between PED and future MACE, which was defined as any incident of revascularization, heart failure hospitalization, stroke, myocardial infarction, re‐transplantation, and death. Patients with PED (n = 27) had more yearly plaque progression (0.50 ± 0.66 vs. 0.15 ± 0.50 mm3/mm/year, P = 0.02) and a higher Δ plaque index (2.41 ± 2.53% vs. 0.69 ± 2.22%, P = 0.01). Patients with PED were more likely to experience MACE during a median follow‐up of 8.2 years (interquartile range [7.6, 8.4]), after adjustment for potential cofounders such as age, high‐density lipoprotein cholesterol levels, total rejection score, baseline International Society for Heart & Lung Transplantation CAV grade, and indication of transplantation. (hazard ratio 2.15, 95% confidence interval [1.09, 4.23], P = 0.03). Conclusions Peripheral endothelial dysfunction is associated with increased plaque progression and adverse long‐term cardiovascular outcomes in transplant patients. PED assessment might be a useful clinical tool for risk stratification after heart transplantation. |
| first_indexed | 2024-04-12T15:15:12Z |
| format | Article |
| id | doaj.art-539f328cc45349ad9cd5eed2913d2ab2 |
| institution | Directory Open Access Journal |
| issn | 2055-5822 |
| language | English |
| last_indexed | 2024-04-12T15:15:12Z |
| publishDate | 2021-12-01 |
| publisher | Wiley |
| record_format | Article |
| series | ESC Heart Failure |
| spelling | doaj.art-539f328cc45349ad9cd5eed2913d2ab22022-12-22T03:27:38ZengWileyESC Heart Failure2055-58222021-12-01865266527410.1002/ehf2.13610Peripheral microvascular dysfunction is associated with plaque progression and adverse long‐term outcomes in heart transplant patientsIlke Ozcan0Takumi Toya1Michel T. Corban2Ali Ahmad3Lilach O. Lerman4Sudhir S. Kushwaha5Amir Lerman6Department of Cardiovascular Medicine Mayo Clinic 200 First Street SW Rochester MN 55902 USADepartment of Cardiovascular Medicine Mayo Clinic 200 First Street SW Rochester MN 55902 USADepartment of Cardiovascular Medicine Mayo Clinic 200 First Street SW Rochester MN 55902 USADepartment of Cardiovascular Medicine Mayo Clinic 200 First Street SW Rochester MN 55902 USADivision of Nephrology and Hypertension Mayo Clinic Rochester MN USADepartment of Cardiovascular Medicine Mayo Clinic 200 First Street SW Rochester MN 55902 USADepartment of Cardiovascular Medicine Mayo Clinic 200 First Street SW Rochester MN 55902 USAAbstract Aims Cardiac allograft vasculopathy (CAV) is the major cause of increased morbidity and mortality after heart transplantation. Peripheral endothelial dysfunction (PED) is associated with early atherosclerosis and future risk of major adverse cardiovascular events (MACE) in non‐heart transplant population. We aimed to investigate the association of PED with future MACE, and plaque progression assessed by intravascular ultrasound (IVUS) after heart transplantation. Methods and results We included 66 transplant patients who underwent serial IVUS surveillance for CAV and baseline assessment of peripheral endothelial function using reactive hyperaemia peripheral arterial tonometry. PED was defined as reactive hyperaemia index < 2. The primary endpoint of the study was to investigate the association of PED with CAV progression assessed by intravascular ultrasound (IVUS). CAV progression was assessed as the change (Δ) in plaque volume divided by segment length, and Δ plaque index (plaque volume/vessel volume), adjusted for the time between IVUS measurements (median 3.0 [2.2, 3.1] years). The secondary endpoint was to investigate the association between PED and future MACE, which was defined as any incident of revascularization, heart failure hospitalization, stroke, myocardial infarction, re‐transplantation, and death. Patients with PED (n = 27) had more yearly plaque progression (0.50 ± 0.66 vs. 0.15 ± 0.50 mm3/mm/year, P = 0.02) and a higher Δ plaque index (2.41 ± 2.53% vs. 0.69 ± 2.22%, P = 0.01). Patients with PED were more likely to experience MACE during a median follow‐up of 8.2 years (interquartile range [7.6, 8.4]), after adjustment for potential cofounders such as age, high‐density lipoprotein cholesterol levels, total rejection score, baseline International Society for Heart & Lung Transplantation CAV grade, and indication of transplantation. (hazard ratio 2.15, 95% confidence interval [1.09, 4.23], P = 0.03). Conclusions Peripheral endothelial dysfunction is associated with increased plaque progression and adverse long‐term cardiovascular outcomes in transplant patients. PED assessment might be a useful clinical tool for risk stratification after heart transplantation.https://doi.org/10.1002/ehf2.13610Heart transplantationPeripheral endothelial functionCardiac allograft vasculopathyReactive hyperaemia peripheral arterial tonometryIntravascular ultrasound |
| spellingShingle | Ilke Ozcan Takumi Toya Michel T. Corban Ali Ahmad Lilach O. Lerman Sudhir S. Kushwaha Amir Lerman Peripheral microvascular dysfunction is associated with plaque progression and adverse long‐term outcomes in heart transplant patients ESC Heart Failure Heart transplantation Peripheral endothelial function Cardiac allograft vasculopathy Reactive hyperaemia peripheral arterial tonometry Intravascular ultrasound |
| title | Peripheral microvascular dysfunction is associated with plaque progression and adverse long‐term outcomes in heart transplant patients |
| title_full | Peripheral microvascular dysfunction is associated with plaque progression and adverse long‐term outcomes in heart transplant patients |
| title_fullStr | Peripheral microvascular dysfunction is associated with plaque progression and adverse long‐term outcomes in heart transplant patients |
| title_full_unstemmed | Peripheral microvascular dysfunction is associated with plaque progression and adverse long‐term outcomes in heart transplant patients |
| title_short | Peripheral microvascular dysfunction is associated with plaque progression and adverse long‐term outcomes in heart transplant patients |
| title_sort | peripheral microvascular dysfunction is associated with plaque progression and adverse long term outcomes in heart transplant patients |
| topic | Heart transplantation Peripheral endothelial function Cardiac allograft vasculopathy Reactive hyperaemia peripheral arterial tonometry Intravascular ultrasound |
| url | https://doi.org/10.1002/ehf2.13610 |
| work_keys_str_mv | AT ilkeozcan peripheralmicrovasculardysfunctionisassociatedwithplaqueprogressionandadverselongtermoutcomesinhearttransplantpatients AT takumitoya peripheralmicrovasculardysfunctionisassociatedwithplaqueprogressionandadverselongtermoutcomesinhearttransplantpatients AT micheltcorban peripheralmicrovasculardysfunctionisassociatedwithplaqueprogressionandadverselongtermoutcomesinhearttransplantpatients AT aliahmad peripheralmicrovasculardysfunctionisassociatedwithplaqueprogressionandadverselongtermoutcomesinhearttransplantpatients AT lilacholerman peripheralmicrovasculardysfunctionisassociatedwithplaqueprogressionandadverselongtermoutcomesinhearttransplantpatients AT sudhirskushwaha peripheralmicrovasculardysfunctionisassociatedwithplaqueprogressionandadverselongtermoutcomesinhearttransplantpatients AT amirlerman peripheralmicrovasculardysfunctionisassociatedwithplaqueprogressionandadverselongtermoutcomesinhearttransplantpatients |