CARDIAC ALLOGRAFT VASCULOPATHY ASSESSED BY QUANTITATIVE CORONARY ANGIOGRAPHY: A SINGLE CENTER PROSPECTIVE STUDY

Purpose: Contradiction of scientific results has been reported regarding risk factors, especially increased resting heart rate, and development of cardiac allograft vasculopathy (CAV).
Methods: Quantitative coronary angiography (QCA) was performed prospectively 1 month and 12 months after heart transplantation in 48 patients between years 2011-2013. Mean lumen diameter (MLD) loss in proximal segments of the left anterior descending (LAD) and the left circumflex (LCX), and in middle segment of the right coronary artery (RCA), was assessed by two independent reviewers. Apart from selected serum biomarker levels, mean heart rate (HR) derived from repeated 24 hour ECG Holter monitoring was studied.
Results: Significant reduction in MLD was documented in all three major vessels (LAD, LCX, RCA) within one year after heart transplantation. Average MLD in LAD was reduced from 3.93 mm to 3.62 mm (p<0.0001), in LCX from 3.67 mm to 3.38 mm (p<0.0001) an in RCA from 3.41 mm to 3.22 mm (p=0.0027). ¨CAV fast progressors¨ were diagnosed if total MLD loss of entire coronary circulation 12 months after transplantation was ≥10 % (14 patients). Serum levels of BNP, Galectin-3 or hsTnT (1 week, 1, 3, 6 and 12 months after transplantation) did not correlate with early CAV development. Mean HR after heart transplantation was not found to be a risk factor for CAV development either (p=0.24 in 1 month, p=0.30 in 12 months after transplantation). Increased heart rate reflected younger age of a donor (p=0.013 in 12 months after transplantation).
Conclusion: CAV is a very rapid process affecting the entire coronary circulation after heart transplantation. Early detection of ¨CAV fast progressors¨ would be crucial to attenuate this process. However, neither selected biomarkers nor elevated mean HR are associated with CAV development in epicardial arteries.