One-year vasculopathy, as defined by an increase in Maximal Intimal Thickness (MIT) of > 0.5mm by intravascular ultrasound was shown to be predictive of 5-year clinical events. This data was presented by Jon Kobashigawa, MD, UCLA Medical School, during the session entitled "Multi-Center Intravascular Ultrasound Validation Study Among Heart Transplant Recipients: Outcomes after 5 years."
Patients with first-year change in MIT 0.5 mm compared to those patients with MIT < 0.5mm had higher incidence of death or graft loss (20.8% vs. 5.9%, p=0.007), more Non-Fatal cardiac events, or more newly occurring angiographic luminal irregularities (65.2% vs. 32.6%, p=0.004).
In a second presentation, Randall Starling, MD, of the Cleveland Clinic Foundation, described the favorable effect of the proliferation signal inhibitor everolimus on cardiac allograft vasculopathy, and its concomitant reduction in acute rejection rates, is maintained through 24 months.
In this 634-patient study conducted in 54 centers worldwide, prospective analysis of the IVUS-population (matched analysis, n=149) was performed. This study, using rigorous IVUS techniques, revealed that the early findings of attenuation of development of intimal thickening by using everolimus remained even on analysis of 2 year end-points.
Dr. Javier Segovia, Clinic Puerta de Hierro, Madrid, reported in a third study that sirolimus, another proliferation signal inhibitor, reduced coronary lesions of patients with established cardiac allograft vasculopathy. In this small trial, there was suggestion of a plaque regression in those treated as compared with conventional immunosuppressive regimens.
Contact: Lauren Mason
International Society for Heart and Lung Transplantation