Clinical and Functional Correlates of Early Microvascular Dysfunction After Heart Transplantation

Authors
François HaddadPrateeti KhazanieTobias DeuseDana WeisshaarJessica ZhouChang Wook NamThu A. VuFatemeh A. GomariMehdi SkhiriAna SimosIngela SchnittgerBojan VrotvecSharon A. HuntWilliam F. Fearon
Department
Dept. of Internal Medicine (내과학)
Issue Date
2012
Citation
Circulation: Heart Failure, Vol.5(6) : 759-768, 2012
ISSN
1941-3289
Abstract
Background—Microvascular dysfunction is emerging as a strong predictor of outcome in heart transplant recipients. At this time, the determinants and consequences of early microvascular dysfunction are not well established. The objective of the study was to determine the risk factors and functional correlates associated with early microvascular dysfunction in heart transplant recipients. Methods and Results—Sixty-three heart transplant recipients who had coronary physiology assessment, right heart catheterization, and echocardiography performed at the time of their first annual evaluation were included in the study. Microvascular dysfunction was assessed using the recently described index of microcirculatory resistance. The presence of microvascular dysfunction, predefined by an index of microcirculatory resistance >20, was observed in 46% of patients at 1 year. A history of acute rejection and undersized donor hearts were associated with microvascular dysfunction at 1 year, with odds ratio of 4.0 (1.3–12.8) and 3.6 (1.2–11.1), respectively. Patients with microvascular dysfunction had lower cardiac index (3.1±0.7 versus 3.5±0.7 L/min per m2; P=0.02) and mild graft dysfunction measured by echocardiography-derived left and right myocardial performance indices ([0.54±0.09 versus 0.43±0.09; P<0.01] and [0.47±0.14 versus 0.32±0.05; P<0.01], respectively). Microvascular dysfunction was also associated with a higher likelihood of death, graft failure, or allograft vasculopathy at 5 years after transplant (hazard ratio, 2.52 [95% CI, 1.04–5.91]). Conclusions—A history of acute rejection during the first year and smaller donor hearts were identified as risk factors for early microvascular dysfunction. Microvascular dysfunction assessed using index of microcirculatory resistances at 1 year was also associated with worse graft function and possibly worse clinical outcomes. Key Words: coronary physiology microcirculation coronary artery disease heart transplantation heart function
URI
http://kumel.medlib.dsmc.or.kr/handle/2015.oak/35413
Appears in Collections:
1. Journal Papers (연구논문) > 1. School of Medicine (의과대학) > Dept. of Internal Medicine (내과학)
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