Is all intimal proliferation created equal in cardiac allograft vasculopathy? The quantity-quality paradox

Mehra, M. R., Ventura, H. O., Uber, P. A., Scott, R. L. and Park, M. H. (2003) Is all intimal proliferation created equal in cardiac allograft vasculopathy? The quantity-quality paradox. Journal of Heart and Lung Transplantation, 22 2: 118-123. doi:10.1016/S1053-2498(02)00492-8

Author Mehra, M. R.
Ventura, H. O.
Uber, P. A.
Scott, R. L.
Park, M. H.
Title Is all intimal proliferation created equal in cardiac allograft vasculopathy? The quantity-quality paradox
Journal name Journal of Heart and Lung Transplantation   Check publisher's open access policy
ISSN 1053-2498
Publication date 2003-02
Sub-type Article (original research)
DOI 10.1016/S1053-2498(02)00492-8
Volume 22
Issue 2
Start page 118
End page 123
Total pages 6
Place of publication Philadelphia, PA, United States
Publisher Elsevier
Language eng
Formatted abstract
Background: Pre-angiographic detection of intimal proliferation using intravascular ultrasound in heart transplant recipients has focused investigators' attention on the prognostic utility of such early information. Not all heart transplant recipients who exhibit a "prognostically relevant" threshold of severe (>0.5 mm) intimal thickening experience cardiac events. We sought to contrast clinical characteristics of heart transplant recipients who have prognostically relevant, severe intimal proliferation and who experience cardiac events with those who remain event free.

Methods: We prospectively followed an inception cohort of 54 consecutive heart transplant recipients with severe intimal proliferation (intimal thickness >0.5mm) of the coronary arteries after index intravascular ultrasound examination to assess the development of cardiac events (sudden cardiac death, myocardial infarction) and/or the necessity for coronary revascularization with percutaneous techniques (angioplasty, atherectomy, stent implantation) or surgical bypass.

Results: Based on the occurrence of adverse cardiac events during the subsequent 24 months, we divided the study cohort into 2 groups: Group 1 (no event, n = 33) and Group 2 (cardiac event, n = 21). Both groups demonstrated similar intimal thickness at the index ultrasound (Group 1, 0.89 ± 0.27 mm, vs Group 2, 0.94 ± 0.36 mm; p = not significant). Those with cardiac events were more likely than those without events to have hyperlipidemia, to have greater exposure to cumulative and average daily prednisone, and to exhibit greater average biopsy rejection scores at follow-up.

Conclusions: These observations underscore the importance of the quality and not merely the quantity of intimal proliferation in determining occurrence of morbid cardiac events and further emphasize the interaction of immunologic and non-immunologic factors in determining event vulnerability in cardiac allograft vasculopathy.
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collection: School of Medicine Publications
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Citation counts: TR Web of Science Citation Count  Cited 13 times in Thomson Reuters Web of Science Article | Citations
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Created: Mon, 14 Mar 2011, 10:12:10 EST