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Cytomegalovirus disease as a possible etiologic factor for early atherosclerosis
B Biocina1, I Husedzinović, Z Sutlić
1Department of Cardiac Surgery, Clinic of Surgery, Clinical Hospital Dubrava, Zagreb, Croatia.
Insights
Cytomegalovirus disease significantly worsens long-term survival after heart transplantation, increasing coronary atherosclerosis. Early cytomegalovirus infection without disease has a less severe impact on patient outcomes.
Area of Science:
- Cardiology
- Infectious Diseases
- Transplantation Immunology
Background:
- Orthotopic heart transplantation is a life-saving procedure.
- Cytomegalovirus (CMV) infection is a common complication post-transplant.
- The impact of CMV infection and disease on long-term heart transplant outcomes requires further elucidation.
Purpose of the Study:
- To analyze the long-term survival of heart transplant recipients.
- To determine the influence of cytomegalovirus infection and disease on survival.
- To identify factors affecting post-transplant outcomes.
Main Methods:
- Retrospective analysis of 284 heart transplant patients followed for at least five years.
- Patients categorized into three groups: no CMV infection, CMV infection only, and CMV disease.
- Survival analysis considered donor/recipient age and sex, rejection episodes, ischemic time, and pulmonary vascular resistance.
Main Results:
- Recipient age was a significant factor influencing survival.
- Patients with cytomegalovirus disease experienced significantly worse long-term survival compared to those with infection only or no infection.
- Increased incidence of coronary atherosclerosis was identified as the cause of death in patients with prior CMV disease.
Conclusions:
- Cytomegalovirus disease, not just infection, is a critical determinant of poor long-term survival in heart transplant recipients.
- CMV disease is strongly associated with the development of fatal coronary atherosclerosis post-transplantation.
- Understanding and managing CMV disease is crucial for improving long-term outcomes in heart transplant patients.
Abstract:
A group of 284 patients who underwent orthotopic heart transplantation between April 1986 to June 1991 and who were followed up for at least five years was analyzed in this paper. Patients were divided into three groups according to the presence or absence of cytomegalovirus infection or disease: patients without infection, patients with serologycaly proven infection and patients with cytomegalovirus disease. The analysis of survival was performed with respect to all major factors that influence survival: age and sex of a donor and a recipient, number of rejection episodes, perioperative ischemic time and pulmonary vascular resistence. A recipient's age was shown to be a significant factor. Patients who experienced at least one episode of cytomegalovirus disease had significantly worse long-term survival compared to those with the infection only or without the infection. That difference was caused by the increased incidence of coronary atherosclerosis, which caused deaths in patients with a previous episode of cytomegalovirus disease. A possible mechanism responsible for this phenomenon is discussed.