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CAV Trajectories Among Patients With No or Mild CAV at 10 Years Posttransplant
Erin Harris1, Nikil Prasad1, Devin Skoll1
1Milstein Division of Cardiology, Department of Medicine, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA.
Insights
Most heart transplant recipients with early cardiac allograft vasculopathy (CAV) do not progress to severe CAV later. This finding suggests routine late screening for CAV may not be necessary for all patients post-heart transplantation.
Area of Science:
- Cardiology
- Transplantation Medicine
- Immunology
Background:
- Cardiac allograft vasculopathy (CAV) significantly impacts heart transplant (HT) recipient outcomes.
- While early CAV trajectories are known, late CAV evolution remains understudied.
Purpose of the Study:
- To determine the prevalence of late CAV progression in HT recipients with minimal CAV at 10 years.
- To identify risk factors associated with late CAV progression.
Main Methods:
- Retrospective analysis of adult HT recipients transplanted between 2000-2008.
- Patients initially classified as ISHLT CAV 0/1 at 10 years were followed for late progression (ISHLT CAV 2/3).
- Comparison of outcomes between progressors and non-progressors.
Main Results:
- Only 8.5% of patients progressed to ISHLT CAV 2/3.
- No significant association was found between late CAV progression and death or retransplantation.
- The majority (91.5%) remained non-progressors.
Conclusions:
- Late progression of cardiac allograft vasculopathy is uncommon in heart transplant recipients with minimal early CAV.
- These findings may help refine recommendations for late-stage CAV surveillance strategies.
Abstract:
Cardiac allograft vasculopathy (CAV) is a major cause of morbidity and mortality following heart transplantation (HT). Prior studies identified distinct CAV trajectories in the early post-HT period with unique predictors, but the evolution of CAV in later periods is not well-described. This study assessed the prevalence of late CAV progression and associated risk factors in HT recipients with ISHLT CAV 0/1 at 10 years post-HT. Consecutive adult patients who underwent HT from January 2000 to December 2008 were evaluated and grouped by CAV trajectories into progressors (developed ISHLT CAV 2/3) or nonprogressors (remained ISHLT CAV 0/1). A total of 130 patients were included with a median age at angiography of 61.7 years and a median follow-up time of 4.8 years. 8.5% progressed to CAV 2/3, while the remaining 91.5% were nonprogressors. Progression was not associated with death or retransplantation (27.3% [progressor] vs. 21.0% [nonprogressor], p = 0.70). These data may inform shared decision-making about late CAV screening.
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