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Long-term outcome after heart transplantation predicted by quantitative myocardial blush grade in coronary
N P Hofmann1, A Voss, H Dickhaus
1Department of Cardiology, University of Heidelberg, Heidelberg, Germany. nina.hofmann@med.uni-heidelberg.de
Insights
Quantifying myocardial blush grade (MBG) during surveillance coronary angiography predicts long-term outcomes after heart transplantation (HT). This method offers a robust prediction of cardiac death and events, improving patient management.
Area of Science:
- Cardiology
- Transplantation Medicine
- Medical Imaging
Background:
- Cardiac allograft vasculopathy (CAV) is a major cause of long-term graft failure after heart transplantation (HT).
- Early detection and prediction of adverse events are crucial for improving patient outcomes post-HT.
Purpose of the Study:
- To investigate if quantifying myocardial blush grade (MBG) during surveillance coronary angiography can predict long-term outcomes in heart transplant recipients.
- To assess the association between MBG and cardiac allograft vasculopathy (CAV) and subsequent cardiac events.
Main Methods:
- A prospective cohort study of 105 heart transplant recipients undergoing surveillance coronary angiography.
- Myocardial blush grade (MBG) was quantified using G(max)/T(max) (contrast agent gray-level intensity plateau divided by time-to-peak intensity).
- Cardiac allograft vasculopathy (CAV) was assessed visually using ISHLT criteria; myocardial perfusion index by cardiac MRI was assessed in a subgroup.
Main Results:
- During a mean follow-up of 2.7 years, 26 patients experienced cardiac events, including 7 cardiac deaths and 19 revascularizations.
- Quantified MBG (G(max)/T(max)) correlated with CAV and subsequent cardiac events.
- Multivariable analysis showed G(max)/T(max) robustly predicted cardiac death (HR=0.2) and cardiac events (HR=0.52), independent of clinical factors and CAV presence.
Conclusions:
- Quantified myocardial blush grade (G(max)/T(max)) is a valuable surrogate marker of microvascular integrity after heart transplantation.
- This parameter provides a robust prediction of cardiac death and revascularization procedures, aiding in long-term patient management.
Abstract:
The purpose of our study was to investigate whether the quantification of myocardial blush grade (MBG) during surveillance coronary angiography can predict long-term outcome after heart transplantation (HT). In 105 HT recipients who underwent cardiac catheterization, cardiac allograft vasculopathy (CAV) was assessed visually using the ISHLT grading scale (prospective cohort study). MBG was quantified by dividing the plateau of contrast agent gray-level intensity (G(max)) by the time-to-peak intensity (T(max)). In a subgroup (n = 72), myocardial perfusion index by cardiac magnetic resonance imaging (CMR) was assessed. During a mean follow-up duration of 2.7 (standard deviation [SD] 1.0) years, 26 patients experienced cardiac events, including 7 with cardiac death and 19 who underwent coronary revascularization. G(max)/T(max) was related to CAV by ISHLT criteria and to subsequent cardiac events. By univariate analysis, patient age, organ age, CAV, MBG and myocardial perfusion index by CMR were all predictive for cardiac events. Multivariable analysis demonstrated that G(max)/T(max) provided the most robust prediction of cardiac death (hazard ratio [HR] = 0.2, 95% confidence interval [CI] = 0.06-0.64, p < 0.01) and cardiac events (HR = 0.52, 95% CI = 0.32-0.84, p < 0.01), beyond clinical parameters and the presence of CAV. G(max)/T(max) is a valuable surrogate parameter of microvascular integrity, which is associated with cardiac death and revascularization procedures after HT.
