Coronary Microcirculatory Dysfunction and Acute Cellular Rejection After Heart Transplantation

Male 03 medical and health sciences 0302 clinical medicine Heart Diseases Microcirculation Heart Transplantation Humans Female Prospective Studies Middle Aged 3. Good health
DOI: 10.1161/circulationaha.121.056158 Publication Date: 2021-09-03T09:22:05Z
ABSTRACT
Background: Acute cellular rejection is a major determinant of mortality and retransplantation after heart transplantation. We sought to evaluate the prognostic implications coronary microcirculatory dysfunction assessed by index resistance (IMR) for risk acute Methods: The present study prospectively enrolled 154 transplant recipients who underwent scheduled angiography invasive physiological assessment 1 month IMR under maximal hyperemia. By measuring hyperemic mean transit time using 3 injections (4 mL each) room-temperature saline hyperemia, was calculated as distal pressure×hyperemic time. primary end point biopsy-proven grade ≥2R during 2 years follow-up transplantation compared multivariable Cox proportional hazards regression according IMR. incremental value IMR, in addition model with clinical factors, evaluated comparison C-index, net reclassification index, integrated discrimination index. Results: age 51.2±13.1 (81.2% male), cumulative incidence 19.0% at years. Patients had significantly higher values than those without (23.1±8.6 versus 16.8±11.1, P =0.002). associated (per 5-U increase: adjusted hazard ratio, 1.18 [95% CI, 1.04–1.34], =0.011) optimal cutoff predict 15. IMR≥15 showed IMR<15 (34.4% 3.8%; 15.3 CI 3.6–65.7], <0.001). Addition variables discriminant ability (C-index 0.87 0.74, <0.001; 1.05, 0.20, Conclusions: Coronary measured early significant association rejection. In surveillance endomyocardial biopsy, stratification could be clinically useful tool identify patients future Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02798731.
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