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[Coronary disease of transplanted heart: prevalence, angiographic and etiopathogenetic aspects]
C Campana1, A Gavazzi, R Marioni
1Divisione di Cardiologia, IRCCS, Policlinico S Matteo, Università degli Studi, Pavia.
Insights
Accelerated coronary artery disease is a significant risk after heart transplantation. This study found a 16% prevalence of coronary artery disease in heart transplant recipients, impacting long-term survival.
Area of Science:
- Cardiology
- Transplantation Medicine
- Immunology
Background:
- Progressive coronary artery disease (CAD) is a primary cause of late mortality post-heart transplantation.
- Accelerated atherosclerosis in cardiac transplant recipients poses a significant clinical challenge.
Purpose of the Study:
- To evaluate the prevalence and clinical/angiographic features of accelerated atherosclerosis in heart transplant patients.
- To assess the incidence and progression of CAD in this population.
Main Methods:
- Retrospective analysis of 156 coronary angiographies from 81 heart transplant patients over 5 years.
- Patients received immunosuppression including cyclosporine, azathioprine, and steroids.
- CAD defined by angiographic luminal diameter reduction.
Main Results:
- A 16% prevalence of CAD was observed in 13 out of 81 patients.
- Annual incidence rates ranged from 14.7% at 1 year to 31.5% at 3 years.
- CAD presentation shifted from monovascular to multivessel involvement over time; clinical issues included 3 deaths and 2 re-transplantations.
Conclusions:
- The prevalence and incidence of CAD post-heart transplantation are comparable to other studies.
- Early detection and management of CAD are crucial for improving long-term outcomes in heart transplant recipients.
Abstract:
Progressive coronary artery disease is the most important factor influencing late mortality after heart transplantation. The aim of the study was to evaluate prevalence and clinical and angiographic findings of accelerated atherosclerosis in cardiac transplanted patients. During the first 5 years of the Heart Transplant Clinical Program at Policlinico S Matteo, Pavia, 81 patients underwent 156 coronary angiographies. The immunosuppressive therapy was based on cyclosporine, azathioprine and steroids; in some patients a reduced immunosuppressive schedule was started because of the presence of adverse effects. Coronary angiographies were performed in 68 patients after 1 year, in 40 patients after 2 years, in 19 patients after 3 years and in 18 patients after 4 years. The presence of coronary artery disease was defined by the angiographic occurrence of any decrease in the luminal diameter (including minor irregularities): according to these criteria coronary artery disease was found in 29 angiographies, performed in 13 patients, with a prevalence of 16% (13/81). An evaluation of the annual incidence showed respectively 14.7% at 1 year, 22.5% at 2 years, 31.5% at 3 years, 22.2% at 4 years. Coronary artery disease involvement was predominantly monovascular (56%) after 1 year and with a multivessel expression in the following years (2-vessel disease 33%, 3-vessel disease 50%). The major clinical problems in the transplanted patients with coronary artery disease were 3 deaths, related with heart failure in 2 cases and with sudden death in 1 case, and a new transplantation procedure in 2 patients. Prevalence and incidence of coronary artery disease observed after heart transplantation in this population were similar to those reported by other Authors.(ABSTRACT TRUNCATED AT 250 WORDS)