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Coronary Angiography for Follow-up of Heart Transplant Recipients: Usefulness of the Gensini Score
Emir Karaçağlar1, Arzu Neslihan Akgün, I Haldun Müderrisoğlu
1From the Department of Cardiology, Ankara Hospital, Başkent University Faculty of Medicine, Ankara, Turkey.
Insights
The Gensini score effectively assesses cardiac allograft vasculopathy severity in heart transplant patients. This tool aids in evaluating coronary artery disease burden and improving long-term transplant survival.
Area of Science:
- Cardiology
- Transplantation Immunology
Background:
- Posttransplant cardiac allograft vasculopathy (CAV) significantly impacts long-term survival after heart transplantation.
- Early diagnosis of CAV is challenging due to denervation of the transplanted heart, preventing angina symptom perception.
Purpose of the Study:
- To evaluate the utility of the Gensini score, a standard coronary artery disease severity index, for assessing cardiac allograft vasculopathy in heart transplant recipients.
- To determine the correlation between the Gensini score and the severity of CAV.
Main Methods:
- Retrospective analysis of 105 heart transplant patients (February 2004 - April 2018).
- Calculation of the Gensini score based on coronary angiography to quantify stenosis severity and location.
- Correlation analysis between Gensini score and diagnosed CAV.
Main Results:
- Cardiac allograft vasculopathy was diagnosed in 21 out of 63 evaluated patients (33.3%).
- The mean Gensini score was 34.8 ± 26.
- A strong correlation was observed between the Gensini score and the severity of cardiac allograft vasculopathy, with scores indicating mild, moderate, and severe disease.
Conclusions:
- The Gensini score offers a valid method for assessing CAV burden in clinical practice.
- Further research is necessary to optimize the identification and treatment of CAV for enhanced long-term outcomes in heart transplant recipients.
Objectives:
Posttransplant cardiac allograft vasculo-pathy affects long-term survival after heart transplant. Because cardiac transplant recipients do not feel angina pectoris as a result of denervation of the transplanted heart graft, early diagnosis is difficult. The Gensini score, a widely used and simple scoring system, can determine the severity of coronary artery disease by angiography. Although this system has been widely used to evaluate natural coronary atherosclerosis, its use in heart transplant recipients has not been studied. Here, we evaluated cardiac allograft vasculo-pathy using the Gensini score.
Materials And Methods:
We retrospectively analyzed 105 heart transplant patients seen between February 2004 and April 2018, including their immunosuppressive therapies. The Gensini score was calculated to determine severity score for each coronary stenosis according to degree of luminal narrowing and location.
Results:
Of 105 heart transplant patients, 21 were diagnosed with cardiac allograft vasculopathy. Most patients received tacrolimus, prednisolone, and mycophenolate mofetil as standard therapy. Of 63 included patients, 21 (33.3%) showed cardiac allograft vasculopathy on coronary angiography. In accordance with the International Society of Heart and Lung Transplantation rating system, 42 of 63 patients (66.6%) were rated as 0 (no detectable angiographic lesions). Mean Gensini score was 34.8 ± 26. In the 21 patients with cardiac allograft vasculopathy, Gensini score showed mild cardiac allograft vas-culopathy (score ≤ 10) in 8 patients (38%), moderate (score > 10 and ≤ 40) in 6 patients (28.5%), and severe (score > 40) in 7 patients (33.3%). Angiographic coronary artery disease burden using Gensini was strongly correlated with cardiac allograft vasculopathy severity.
Conclusions:
The Gensini score could provide valid assessment of cardiac allograft vasculopathy burden for use in clinical practice. However, more research is needed to identify and treat cardiac allograft vasculopathy for successful long-term survival of heart transplant patients.
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