Predictive model to assess risk of cardiac allograft vasculopathy: An intravascular ultrasound study

Mehra, Mandeep R., Ventura, Hector O., Chambers, Richard, Collins, Tyrone J., Ramee, Stephen R., Kates, Marc A., Smart, Frank W. and Stapleton, Dwight D. (1995) Predictive model to assess risk of cardiac allograft vasculopathy: An intravascular ultrasound study. Journal of the American College of Cardiology, 26 6: 1537-1544. doi:10.1016/0735-1097(95)00357-6

Author Mehra, Mandeep R.
Ventura, Hector O.
Chambers, Richard
Collins, Tyrone J.
Ramee, Stephen R.
Kates, Marc A.
Smart, Frank W.
Stapleton, Dwight D.
Title Predictive model to assess risk of cardiac allograft vasculopathy: An intravascular ultrasound study
Journal name Journal of the American College of Cardiology   Check publisher's open access policy
ISSN 0735-1097
Publication date 1995-11-01
Year available 1995
Sub-type Article (original research)
DOI 10.1016/0735-1097(95)00357-6
Open Access Status Not Open Access
Volume 26
Issue 6
Start page 1537
End page 1544
Total pages 8
Place of publication San Diego, CA, United States
Publisher Elsevier
Language eng
Formatted abstract
Objectives: This study was performed to assess the influence and interdependence of immunologic and nonimmunologic risk factors in the development of cardiac allograft vasculopathy. Another primary objective,vas to establish a clinically useful model for risk assessment of cardiac allograft vasculopathy that would facilitate identifying those heart transplant recipients likely to have severe intimal proliferation and thereby at greatest risk for adverse clinical events.

To our knowledge, no comprehensive intravascular ultrasound study has assessed the relative influences of both nonimmunologic and immunologic factors in the development of cardiac allograft vasculopathy, currently the major limitation to long-term cardiac allograft survival.

Methods: Using a computer-assisted model of stepwise logistic regression, immunologic and nonimmunologic risk factors were evaluated to help identify the development of severe intimal thickening in 101 subjects who underwent intravascular ultrasound. Prospective validation of the findings was performed in a separate consecutive cohort of 37 heart transplant recipients, and the accuracy of this model to predict a relative risk >1 for the development of severe intimal hyperplasia was assessed.

Results: Significant independent predictors of severe intimal hyperplasia in this model included a donor age >35 years, a first-year mean biopsy score >1 (a measure not only of severity of rejection, but also of frequency of insidious rejection) and hypertriglyceridemia at two incremental levels of risk (150 to 250 mg/dl [1.70 to 2.83 mmol/liter] and >250 mg/dl [2.83 mmol/liter]). Based on the absence (0) or presence (1) of these factors, 12 individual categories of risk were ascertained with increasing relative risks and predicted probabilities for severe intimal hyperplasia. Prospective validation of this model revealed a sensitivity and specificity of 70% and 90%, respectively, and the positive and negative predictive values were 85% and 80%, respectively. Additionally, subjects with severe intimal thickening had a fourfold higher cardiac event rate than those without severe intimal proliferation on intravascular ultrasound.

Conclusions: This study establishes a clinically useful predictive model that can be applied to individual heart transplant recipients to assess their risk for developing significant cardiac allograft vasculopathy and, thus, aids in the identification of patients at risk for cardiac events in whom closer surveillance and risk factor modification may be warranted.
Keyword Cardiac & Cardiovascular Systems
Cardiovascular System & Cardiology
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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Created: Mon, 14 Mar 2011, 20:11:29 EST