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254: Clinical and functional determinants of coronary flow reserve in heart transplantation: A contrast-enhanced echocardiographic study
The Journal of Heart and Lung Transplantation Volume 26, Number 2S
3.1 %, p ⬍ 0.001). Global left ventricular function, immunosuppressive and inflammatory parameters did not differ. Conclusions: In male orthotopic heart transplant recipients, gender mismatch is associated with an adverse outcome caused by increased number and increased severity of graft rejections.
Abstracts
S151
1B⫽2; 2⫽3; 3A⫽4; 3B⫽5; 4⫽6) in the first year and in whole follow-up. RS including only severe grades (⫽3A) were also calculated. CAV onset was defined as any lesion ⬎ or ⫽10%. The coronary tree was divided into 17 traits and a CAV severity/diffusion index (SDI) was calculated for each patient summing up the scores assigned to all lesions (10% stenosis⫽1; 20%⫽2; 30%⫽3; 40%⫽4; 50%⫽5; 60%⫽6; 70%⫽7; 80%⫽8; 90%⫽9; 100%⫽10). Results: At univariate analysis CFR was related to CAV (p⬍0.0001), male recipient gender (p⫽0.01), ejection fraction (p⫽0.009), haemoglobin (p⫽0.003), therapy with prednisone (p⫽0.008), interventricular septum thickness (p⫽0.006), SDI and SDI/traits number (p⬍0.0001 and p⬍0.0001, respectively), number of diseased traits (p⬍0.0001), and ticlopidine therapy (p⫽0.03). At stepwise logistic regression analysis CFR was related to CAV presence (b 0.439, p⫽0.001), ticlopidine therapy ( -0.212, p⫽0.01), interventricular septum thickness ( 0.233, p⫽0.009), SDI and SDI/traits number (-0.690, p⬍0.0001 and  -0.559, p⫽0.008, respectively). Conclusions: The presence of CAV and, above all, its severity/ diffusion independently contribute to a reduced CFR in HT. This microvascular dysfunction may contribute to the late outcome in HT patients with coronary occlusive disease.
255 EFFECT OF SYMPATHETIC REINNERVATION ON EXERCISE TOLERABILITY AND QUALITY OF LIFE IN JAPANESE HEART TRANSPLANT PATIENTS K. Shitakura,1 S. Nunoda,1 K. Okajima,1 O. Matsuoka,1 S. Oinuma,1 Y. Kubo,1 K. Otsuka,1 1Department of Medicine, Tokyo Women’s Medical University Medical Center East, Tokyo, Japan
Figure 1: Mean survival of the two groups. 254 CLINICAL AND FUNCTIONAL DETERMINANTS OF CORONARY FLOW RESERVE IN HEART TRANSPLANTATION: A CONTRASTENHANCED ECHOCARDIOGRAPHIC STUDY F. Tona,1 A.L.P. Caforio,1 R. Montisci,2 A. Gambino,3 G. Feltrin,3 G. Dequal,1 A. Ramondo,1 A. Angelini,4 G. Gerosa,3 S. Iliceto,1 1 Cardiology, University of Padova, Padova, Italy; 2Cardiology, University of Cagliari, Cagliari, Italy; 3Cardiovascular Surgery, University of Padova, Padova, Italy; 4Cardiovascular Pathology, University of Padova, Padova, Italy Purpose: Coronary flow reserve (CFR) is increasingly used to assess the functional significance of cardiac allograft vasculopathy (CAV). Aim of this study was to evaluate determinants of CFR in heart transplantation (HT). Methods and Materials: CFR was measured in the left anterior descending coronary artery by contrast-enhanced transthoracic echocardiography (CE-TTE) in 73 HT recipients (59 M, aged 50 ⫾ 12 years at HT, at 8 ⫾ 4.5 years after HT). CFR was calculated as the ratio of hyperemic (adenosine infusion at a rate of 0.14 mg/kg per min for 5 min) to basal diastolic flow velocity. CFR was measured blindly from angiography. Rejection scores (RS) were calculated (International Society for Heart and Lung Transplantation grades: 0⫽0; 1A⫽1;
Purpose: Little is known about the effect of sympathetic reinnervation after heart transplantation (HTx) on exercise performance and quality of life (QOL), especially in Japanese recipients. Methods and Materials: The subjects consisted of 23 Japanese HTx patients (7 to 53 years old at HTx, 7 females, 12 months to 15 years after HTx). The heart rate (HR) response and its relation to exercise tolerability were examined by using symptom-limited treadmill exercise tests with expired gas analysis. 123I-labeled MIBG studies were used to evaluate the extent of myocardial sympathetic reinnervation after HTx. Intensity of myocardial MIBG uptake was quantified by a heart-to-mediastinum ratio (HMR), and the regional distribution of MIBG was determined by tomographic studies. To measure QOL, the Short Form 36-Item health survey (SF-36) was used before and after HTx in adult recipients. Results: Relationship between the peak VO2 and the HR response during exercise was observed, however, HTx patients showed lower values in % peak VO2, % AT, peak HR and peak VO2/HR in comparison with those in healthy control (Cont) (mean Cont v. HTx patients, 119.0 v. 76.8 in % peak VO2, 133.7 v. 92.1 in % AT, 190 v. 142 in peak HR, 17.2 v. 11.1 in peak VO2/HR, respectively). Correlation between HMR and maximum HR (R⫽0.51), peak VO2 (R⫽0.39) and % peak VO2 (R⫽0.65) during exercise were observed. In all HTx patients, myocardial MIBG uptake was apparent in the anterior region. Peak VO2 and AT in HTx patients were correlated with physical component summary and mental component summary in SF-36 (peak VO2: R⫽0.55, 0.65, AT: R⫽0.52, 0.67, respectively). 3 of 4 patients who showed low HMR (ⱕ1.45) demonstrated lower QOL. Conclusions: Exercise tolerability in HTx patients is lower than in healthy controls. The sympathetic reinnervation was associated with HR response, exercise tolerability and QOL.
3.1 %, p ⬍ 0.001). Global left ventricular function, immunosuppressive and inflammatory parameters did not differ. Conclusions: In male orthotopic heart transplant recipients, gender mismatch is associated with an adverse outcome caused by increased number and increased severity of graft rejections.
Abstracts
S151
1B⫽2; 2⫽3; 3A⫽4; 3B⫽5; 4⫽6) in the first year and in whole follow-up. RS including only severe grades (⫽3A) were also calculated. CAV onset was defined as any lesion ⬎ or ⫽10%. The coronary tree was divided into 17 traits and a CAV severity/diffusion index (SDI) was calculated for each patient summing up the scores assigned to all lesions (10% stenosis⫽1; 20%⫽2; 30%⫽3; 40%⫽4; 50%⫽5; 60%⫽6; 70%⫽7; 80%⫽8; 90%⫽9; 100%⫽10). Results: At univariate analysis CFR was related to CAV (p⬍0.0001), male recipient gender (p⫽0.01), ejection fraction (p⫽0.009), haemoglobin (p⫽0.003), therapy with prednisone (p⫽0.008), interventricular septum thickness (p⫽0.006), SDI and SDI/traits number (p⬍0.0001 and p⬍0.0001, respectively), number of diseased traits (p⬍0.0001), and ticlopidine therapy (p⫽0.03). At stepwise logistic regression analysis CFR was related to CAV presence (b 0.439, p⫽0.001), ticlopidine therapy ( -0.212, p⫽0.01), interventricular septum thickness ( 0.233, p⫽0.009), SDI and SDI/traits number (-0.690, p⬍0.0001 and  -0.559, p⫽0.008, respectively). Conclusions: The presence of CAV and, above all, its severity/ diffusion independently contribute to a reduced CFR in HT. This microvascular dysfunction may contribute to the late outcome in HT patients with coronary occlusive disease.
255 EFFECT OF SYMPATHETIC REINNERVATION ON EXERCISE TOLERABILITY AND QUALITY OF LIFE IN JAPANESE HEART TRANSPLANT PATIENTS K. Shitakura,1 S. Nunoda,1 K. Okajima,1 O. Matsuoka,1 S. Oinuma,1 Y. Kubo,1 K. Otsuka,1 1Department of Medicine, Tokyo Women’s Medical University Medical Center East, Tokyo, Japan
Figure 1: Mean survival of the two groups. 254 CLINICAL AND FUNCTIONAL DETERMINANTS OF CORONARY FLOW RESERVE IN HEART TRANSPLANTATION: A CONTRASTENHANCED ECHOCARDIOGRAPHIC STUDY F. Tona,1 A.L.P. Caforio,1 R. Montisci,2 A. Gambino,3 G. Feltrin,3 G. Dequal,1 A. Ramondo,1 A. Angelini,4 G. Gerosa,3 S. Iliceto,1 1 Cardiology, University of Padova, Padova, Italy; 2Cardiology, University of Cagliari, Cagliari, Italy; 3Cardiovascular Surgery, University of Padova, Padova, Italy; 4Cardiovascular Pathology, University of Padova, Padova, Italy Purpose: Coronary flow reserve (CFR) is increasingly used to assess the functional significance of cardiac allograft vasculopathy (CAV). Aim of this study was to evaluate determinants of CFR in heart transplantation (HT). Methods and Materials: CFR was measured in the left anterior descending coronary artery by contrast-enhanced transthoracic echocardiography (CE-TTE) in 73 HT recipients (59 M, aged 50 ⫾ 12 years at HT, at 8 ⫾ 4.5 years after HT). CFR was calculated as the ratio of hyperemic (adenosine infusion at a rate of 0.14 mg/kg per min for 5 min) to basal diastolic flow velocity. CFR was measured blindly from angiography. Rejection scores (RS) were calculated (International Society for Heart and Lung Transplantation grades: 0⫽0; 1A⫽1;
Purpose: Little is known about the effect of sympathetic reinnervation after heart transplantation (HTx) on exercise performance and quality of life (QOL), especially in Japanese recipients. Methods and Materials: The subjects consisted of 23 Japanese HTx patients (7 to 53 years old at HTx, 7 females, 12 months to 15 years after HTx). The heart rate (HR) response and its relation to exercise tolerability were examined by using symptom-limited treadmill exercise tests with expired gas analysis. 123I-labeled MIBG studies were used to evaluate the extent of myocardial sympathetic reinnervation after HTx. Intensity of myocardial MIBG uptake was quantified by a heart-to-mediastinum ratio (HMR), and the regional distribution of MIBG was determined by tomographic studies. To measure QOL, the Short Form 36-Item health survey (SF-36) was used before and after HTx in adult recipients. Results: Relationship between the peak VO2 and the HR response during exercise was observed, however, HTx patients showed lower values in % peak VO2, % AT, peak HR and peak VO2/HR in comparison with those in healthy control (Cont) (mean Cont v. HTx patients, 119.0 v. 76.8 in % peak VO2, 133.7 v. 92.1 in % AT, 190 v. 142 in peak HR, 17.2 v. 11.1 in peak VO2/HR, respectively). Correlation between HMR and maximum HR (R⫽0.51), peak VO2 (R⫽0.39) and % peak VO2 (R⫽0.65) during exercise were observed. In all HTx patients, myocardial MIBG uptake was apparent in the anterior region. Peak VO2 and AT in HTx patients were correlated with physical component summary and mental component summary in SF-36 (peak VO2: R⫽0.55, 0.65, AT: R⫽0.52, 0.67, respectively). 3 of 4 patients who showed low HMR (ⱕ1.45) demonstrated lower QOL. Conclusions: Exercise tolerability in HTx patients is lower than in healthy controls. The sympathetic reinnervation was associated with HR response, exercise tolerability and QOL.