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TCT-818 Early Left Ventricular Dysfunction is Associated with Cardiac Allograft Vasculopathy and Late Mortality After Heart Transplantation
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 68, NO. 18, SUPPL B, 2016
significantly higher with NH-EMB compared to TH-EMB. Hospital procedure volume is a significant factor affecting the overall procedural outcomes of EMB. CATEGORIES STRUCTURAL: Heart Failure TCT-817 High-Sensitivity C-reactive Protein Predicts New-Onset Heart Failure in Patients Treated with Moderate-Intensity Statin for Primary Prevention Yoonjee Park,1 Seung-Woon Rha,2 Byoung Geol Choi,3 Jae Kyeong Byun,4 Se Yeon Choi,5 Jun Hyuk Kang,6 Woo Hyeun Kim,7 Ja Yeon Choi,8 James Hall,9 Sung Hun Park,10 SunKi Lee,11 Hu Li,12 Jin Oh Na,13 Cheol Ung Choi,14 Jin Won Kim,15 Hong Euy Lim,16 Eung Ju Kim,17 Chang Gyu Park,18 Hong-Seog Seo,19 Dong Joo Oh20 1 Korea University Guro Hospital, Seoul, Korea, Republic of; 2Korea University Guro Hospital, Seoul, Korea, Republic of; 3Korea University Guro Hospital, Huelva; 4The James Cook University Hospital; 5Durham University; 6Royal Infirmary of Edinburgh; 7The James Cook University Hospital; 8The James Cook University Hospital; 9The James Cook University Hospital, United States; 10The James Cook University Hospital; 11The James Cook University Hospital; 12Korea University Anam Hospital; 13Samsung medical center; 14Korea University Guro Hospital, Seoul, Korea, Republic of; 15Unknown, Seoul, Korea, Republic of; 16Shree B.D. Mehta Mahavir Heart Institute, Surat, Gujarat, India; 17 Pariyaram Medical College, Kannur, Kerala, India; 18Apollo Hospitals International Limited, Gandhinagar, Gujarat, India; 19Unknown, Seoul, Korea, Republic of; 20Korea university Guro Hospital, Seoul, Korea, Republic of BACKGROUND The inflammatory biomarker high-sensitivity C-reactive protein (hsCRP) is known to be associated with the progression and worsening of heart failure (HF). We evaluated the clinical significance of hsCRP on the development of new onset HF in patients (pts) taking moderate-intensity statin for primary prevention. METHODS Pts without HF at baseline were enrolled and divided into 4 quartiles according to hsCRP levels. HF was defined as N-terminal pro-B-type natriuretic peptide (NT-proBNP) > 400 pg/ml. New-onset HF as primary endpoint and other cardiovascular events as secondary endpoints were evaluated up to 9 years. RESULTS Compared to the lowest quartile (< 0.46 mg/L, n¼1224), the highest quartile (>1.86 mg/L, n¼1194) of hsCRP was associated with a higher incidence of new-onset HF [OR¼ 2.28, (95% CI 1.63-3.20), P <0.001]. Even after proportional hazard cox-regression adjusted by age, gender, cardiovascular comorbidities including arrhythmia, hypertension, diabetes, chronic kidney disease, laboratory parameters and medications including types of statins, there was a weaker but still significant relationship between higher levels of hsCRP and the development of new-onset HF [HR¼ 1.74, (95% CI 1.23-2.46), P ¼0.002, figure].
CONCLUSION In our study, hsCRP levels remaining high even after moderate-intensity statin treatment significantly predicted the development of new-onset HF during long-term follow-up. Risk stratification according to the level of hsCRP may help identify pts who need additional attention for future deterioration of cardiac function. CATEGORIES STRUCTURAL: Heart Failure
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TCT-818 Early Left Ventricular Dysfunction is Associated with Cardiac Allograft Vasculopathy and Late Mortality After Heart Transplantation Kozo Okada,1 Yasuhiro Honda,2 Helen Luikart,3 Paul Yock,4 Peter J. Fitzgerald,5 Alan Yeung,6 Hannah Valantine,7 Kiran Khush,8 William Fearon9 1 Stanford University, Stanford, California, United States; 2Stanford University, Stanford, California, United States; 3Division of Cardiovascular Medicine, Stanford University School of Medicine; 4 Stanford University Biodesign Program, Stanford, California, United States; 5Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, United States; 6Stanford University Medical Center, Stanford, California, United States; 7 Division of Cardiovascular Medicine, Stanford University School of Medicine; 8San Francisco, California, United States; 9Stanford University Medical Center, Stanford, California, United States BACKGROUND Little is known about the prognostic value of depressed left ventricular ejection fraction (LVEF) and its relationship to cardiac allograft vasculopathy (CAV) early after heart transplantation. METHODS We evaluated 101 cardiac transplant recipients who underwent serial (baseline and 1 year post-transplant) intravascular ultrasound (IVUS) of the left anterior descending artery (LAD) and echocardiography. Serial invasive physiology measurements were also performed (fractional flow reserve (FFR), coronary flow reserve (CFR) and the index of microcirculatory resistance (IMR)) in 60 patients. LV dysfunction was defined as LVEF <50% at 1 year. RESULTS At 1 year post-transplant, 10 patients had LV dysfunction and, among them, 6 had significant LV dysfunction (LVEF <45%). Baseline IVUS and physiology parameters did not differ significantly between patients with and without LV dysfunction. Change over the first year in standard IVUS indices (vessel, lumen and intimal volumes), FFR and CFR were not significantly different between the two groups. In contrast, the rates of acute cellular rejection (grade 2R) and an increase in IMR during the first year were significantly higher in patients with LV dysfunction (Figure). Paradoxical vessel remodeling of the proximal LAD (an important predictor for late mortality) tended to be higher in patients with LV dysfunction (70.0% vs. 42.7%, p¼0.098). Over a median follow-up of 4.8 years, there was a significantly lower event-free survival rate in patients with LV dysfunction at 1 year compared to those without, which was especially apparent when analyzing patients with vs. without significant LV dysfunction (hazard ratio ¼ 4.5 [1.4-11.7], p<0.05).
CONCLUSION Early LV dysfunction is associated with acute cellular rejection, CAV progression (IMR, paradoxical remodeling of the proximal LAD) and late mortality, suggesting that this noninvasive measure (LVEF) is another important method for predicting adverse outcome after heart transplantation. CATEGORIES STRUCTURAL: Heart Failure TCT-819 Clinical Outcome in Patients with Heart Failure and Moderate Aortic Stenosis Lennart van Gils,1 Marie-Annick Clavel,2 Mara Vollema,3 Victoria Delgado,4 Tamim Nazif,5 Ernest Spitzer,6 Rebecca Hahn,7 Jeroen Bax,8 Martin Leon,9 Philippe Pibarot,10 Nicolas Van Mieghem11
significantly higher with NH-EMB compared to TH-EMB. Hospital procedure volume is a significant factor affecting the overall procedural outcomes of EMB. CATEGORIES STRUCTURAL: Heart Failure TCT-817 High-Sensitivity C-reactive Protein Predicts New-Onset Heart Failure in Patients Treated with Moderate-Intensity Statin for Primary Prevention Yoonjee Park,1 Seung-Woon Rha,2 Byoung Geol Choi,3 Jae Kyeong Byun,4 Se Yeon Choi,5 Jun Hyuk Kang,6 Woo Hyeun Kim,7 Ja Yeon Choi,8 James Hall,9 Sung Hun Park,10 SunKi Lee,11 Hu Li,12 Jin Oh Na,13 Cheol Ung Choi,14 Jin Won Kim,15 Hong Euy Lim,16 Eung Ju Kim,17 Chang Gyu Park,18 Hong-Seog Seo,19 Dong Joo Oh20 1 Korea University Guro Hospital, Seoul, Korea, Republic of; 2Korea University Guro Hospital, Seoul, Korea, Republic of; 3Korea University Guro Hospital, Huelva; 4The James Cook University Hospital; 5Durham University; 6Royal Infirmary of Edinburgh; 7The James Cook University Hospital; 8The James Cook University Hospital; 9The James Cook University Hospital, United States; 10The James Cook University Hospital; 11The James Cook University Hospital; 12Korea University Anam Hospital; 13Samsung medical center; 14Korea University Guro Hospital, Seoul, Korea, Republic of; 15Unknown, Seoul, Korea, Republic of; 16Shree B.D. Mehta Mahavir Heart Institute, Surat, Gujarat, India; 17 Pariyaram Medical College, Kannur, Kerala, India; 18Apollo Hospitals International Limited, Gandhinagar, Gujarat, India; 19Unknown, Seoul, Korea, Republic of; 20Korea university Guro Hospital, Seoul, Korea, Republic of BACKGROUND The inflammatory biomarker high-sensitivity C-reactive protein (hsCRP) is known to be associated with the progression and worsening of heart failure (HF). We evaluated the clinical significance of hsCRP on the development of new onset HF in patients (pts) taking moderate-intensity statin for primary prevention. METHODS Pts without HF at baseline were enrolled and divided into 4 quartiles according to hsCRP levels. HF was defined as N-terminal pro-B-type natriuretic peptide (NT-proBNP) > 400 pg/ml. New-onset HF as primary endpoint and other cardiovascular events as secondary endpoints were evaluated up to 9 years. RESULTS Compared to the lowest quartile (< 0.46 mg/L, n¼1224), the highest quartile (>1.86 mg/L, n¼1194) of hsCRP was associated with a higher incidence of new-onset HF [OR¼ 2.28, (95% CI 1.63-3.20), P <0.001]. Even after proportional hazard cox-regression adjusted by age, gender, cardiovascular comorbidities including arrhythmia, hypertension, diabetes, chronic kidney disease, laboratory parameters and medications including types of statins, there was a weaker but still significant relationship between higher levels of hsCRP and the development of new-onset HF [HR¼ 1.74, (95% CI 1.23-2.46), P ¼0.002, figure].
CONCLUSION In our study, hsCRP levels remaining high even after moderate-intensity statin treatment significantly predicted the development of new-onset HF during long-term follow-up. Risk stratification according to the level of hsCRP may help identify pts who need additional attention for future deterioration of cardiac function. CATEGORIES STRUCTURAL: Heart Failure
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TCT-818 Early Left Ventricular Dysfunction is Associated with Cardiac Allograft Vasculopathy and Late Mortality After Heart Transplantation Kozo Okada,1 Yasuhiro Honda,2 Helen Luikart,3 Paul Yock,4 Peter J. Fitzgerald,5 Alan Yeung,6 Hannah Valantine,7 Kiran Khush,8 William Fearon9 1 Stanford University, Stanford, California, United States; 2Stanford University, Stanford, California, United States; 3Division of Cardiovascular Medicine, Stanford University School of Medicine; 4 Stanford University Biodesign Program, Stanford, California, United States; 5Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, United States; 6Stanford University Medical Center, Stanford, California, United States; 7 Division of Cardiovascular Medicine, Stanford University School of Medicine; 8San Francisco, California, United States; 9Stanford University Medical Center, Stanford, California, United States BACKGROUND Little is known about the prognostic value of depressed left ventricular ejection fraction (LVEF) and its relationship to cardiac allograft vasculopathy (CAV) early after heart transplantation. METHODS We evaluated 101 cardiac transplant recipients who underwent serial (baseline and 1 year post-transplant) intravascular ultrasound (IVUS) of the left anterior descending artery (LAD) and echocardiography. Serial invasive physiology measurements were also performed (fractional flow reserve (FFR), coronary flow reserve (CFR) and the index of microcirculatory resistance (IMR)) in 60 patients. LV dysfunction was defined as LVEF <50% at 1 year. RESULTS At 1 year post-transplant, 10 patients had LV dysfunction and, among them, 6 had significant LV dysfunction (LVEF <45%). Baseline IVUS and physiology parameters did not differ significantly between patients with and without LV dysfunction. Change over the first year in standard IVUS indices (vessel, lumen and intimal volumes), FFR and CFR were not significantly different between the two groups. In contrast, the rates of acute cellular rejection (grade 2R) and an increase in IMR during the first year were significantly higher in patients with LV dysfunction (Figure). Paradoxical vessel remodeling of the proximal LAD (an important predictor for late mortality) tended to be higher in patients with LV dysfunction (70.0% vs. 42.7%, p¼0.098). Over a median follow-up of 4.8 years, there was a significantly lower event-free survival rate in patients with LV dysfunction at 1 year compared to those without, which was especially apparent when analyzing patients with vs. without significant LV dysfunction (hazard ratio ¼ 4.5 [1.4-11.7], p<0.05).
CONCLUSION Early LV dysfunction is associated with acute cellular rejection, CAV progression (IMR, paradoxical remodeling of the proximal LAD) and late mortality, suggesting that this noninvasive measure (LVEF) is another important method for predicting adverse outcome after heart transplantation. CATEGORIES STRUCTURAL: Heart Failure TCT-819 Clinical Outcome in Patients with Heart Failure and Moderate Aortic Stenosis Lennart van Gils,1 Marie-Annick Clavel,2 Mara Vollema,3 Victoria Delgado,4 Tamim Nazif,5 Ernest Spitzer,6 Rebecca Hahn,7 Jeroen Bax,8 Martin Leon,9 Philippe Pibarot,10 Nicolas Van Mieghem11