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CARDIAC ALLOGRAFT HYPERTROPHY: AN IMPORTANT PROGNOSTIC MARKER FOR CARDIAC ALLOGRAFT VASCULOPATHY
E927 JACC March 27, 2012 Volume 59, Issue 13
Heart Failure CARDIAC ALLOGRAFT HYPERTROPHY: AN IMPORTANT PROGNOSTIC MARKER FOR CARDIAC ALLOGRAFT VASCULOPATHY ACC Moderated Poster Contributions McCormick Place South, Hall A Monday, March 26, 2012, 9:30 a.m.-10:30 a.m.
Session Title: Long-term Issues in Heart Transplantation Abstract Category: 13. Heart Failure: Therapy Presentation Number: 1223-456 Authors: Halit Yerebakan, Mengxi Ji, Alexandra Ross, Jeffrey Jiang, Sophie Jones, Lori Soni, Michael Argenziano, Craig Smith, Hiroo Takayama, Yoshifumi Naka, P. Christian Schulze, Faisal Cheema, Columbia University Medical Center, New York, NY, USA Background: There is scarce literature on the onset, progression and severity of cardiac hypertrophy and its effect on patient outcomes undergoing orthotopic heart transplantation (OHTx). We sought to identify any association between the development of cardiac allograft hypertrophy and incidence of cardiac allograft vasculopathy (CAV), biopsy-proven acute cellular rejection or long-term survival. Methods: This was a retrospective study of adult OHTx patients from 2003-2010. After excluding those patients for whom serial echocardiographic reports were not available, a cohort of 241 patients was studied. Serial transthoracic echocardiograms and endomyocardial biopsies were collected with other demographic and clinical data. Left ventricular mass(LVM) was calculated as 0.8(1.04((LVDD+EDPWT+EDST)^3)-(LVDD^3))+0.6. Patients were classified as having severe (>225g) or normal (<=225g) LVM. CAV above ISHLT grade 2 was considered significant and development treated as a time to failure variable. Results: Of our patient cohort, 20.75% developed severe LVM postoperatively. The mean age across all patients was 52.311.6 and with mean BMI of 25.75.0. Patients with severe LVM had significantly worse long-term survival left-censored at 1 year (p=0.016) when compared with normal patients. The severe group also experienced decreased freedom from CAV (p=0.02). Preoperative gender mismatch, female recipients, BMI were significant predictors (p<0.05) for development of severe LVM. Conclusion: The prevalence of increased LVM in cardiac transplant recipients is highly associated with development of CAV and significantly affects long-term mortality. It is critical to consider independent predictors for the development of severe LVM, such as high BMI and donor-recipient gender mismatch when accepting organs. Meticulous screening for LVM and the introduction of appropriate management in its early stages may be helpful in reducing the development of CAV and long-term mortality amongst heart transplant recipients.
Heart Failure CARDIAC ALLOGRAFT HYPERTROPHY: AN IMPORTANT PROGNOSTIC MARKER FOR CARDIAC ALLOGRAFT VASCULOPATHY ACC Moderated Poster Contributions McCormick Place South, Hall A Monday, March 26, 2012, 9:30 a.m.-10:30 a.m.
Session Title: Long-term Issues in Heart Transplantation Abstract Category: 13. Heart Failure: Therapy Presentation Number: 1223-456 Authors: Halit Yerebakan, Mengxi Ji, Alexandra Ross, Jeffrey Jiang, Sophie Jones, Lori Soni, Michael Argenziano, Craig Smith, Hiroo Takayama, Yoshifumi Naka, P. Christian Schulze, Faisal Cheema, Columbia University Medical Center, New York, NY, USA Background: There is scarce literature on the onset, progression and severity of cardiac hypertrophy and its effect on patient outcomes undergoing orthotopic heart transplantation (OHTx). We sought to identify any association between the development of cardiac allograft hypertrophy and incidence of cardiac allograft vasculopathy (CAV), biopsy-proven acute cellular rejection or long-term survival. Methods: This was a retrospective study of adult OHTx patients from 2003-2010. After excluding those patients for whom serial echocardiographic reports were not available, a cohort of 241 patients was studied. Serial transthoracic echocardiograms and endomyocardial biopsies were collected with other demographic and clinical data. Left ventricular mass(LVM) was calculated as 0.8(1.04((LVDD+EDPWT+EDST)^3)-(LVDD^3))+0.6. Patients were classified as having severe (>225g) or normal (<=225g) LVM. CAV above ISHLT grade 2 was considered significant and development treated as a time to failure variable. Results: Of our patient cohort, 20.75% developed severe LVM postoperatively. The mean age across all patients was 52.311.6 and with mean BMI of 25.75.0. Patients with severe LVM had significantly worse long-term survival left-censored at 1 year (p=0.016) when compared with normal patients. The severe group also experienced decreased freedom from CAV (p=0.02). Preoperative gender mismatch, female recipients, BMI were significant predictors (p<0.05) for development of severe LVM. Conclusion: The prevalence of increased LVM in cardiac transplant recipients is highly associated with development of CAV and significantly affects long-term mortality. It is critical to consider independent predictors for the development of severe LVM, such as high BMI and donor-recipient gender mismatch when accepting organs. Meticulous screening for LVM and the introduction of appropriate management in its early stages may be helpful in reducing the development of CAV and long-term mortality amongst heart transplant recipients.