PET-CT Defined Micro-Vascular Dysfunction and Cardiac Allograft Vasculopathy Risk Factors in Heart Transplant Recipients

IF 1.9 4区医学 Q2 SURGERY Clinical Transplantation Pub Date : 2024-10-16 DOI:10.1111/ctr.15445

Assi Milwidsky, Marvyn A. Chan, Mark Travin, Christiana Gjelaj, Omar Saeed, Sasa Vukelic, Yogita Rochlani, Shivank Madan, Julia J. Shin, Daniel B. Sims, Sandhya Murthy, Patricia Chavez, Ulrich P. Jorde, Snehal R. Patel

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Abstract

Microvascular dysfunction (MVD) is considered a form of cardiac allograft vasculopathy (CAV), independently associated with poor prognosis after heart transplantation (HTX). It is unknown whether traditional risk factors for CAV are also applicable to MVD. We retrospectively analyzed factors associated with MVD in 94 HTX recipients who completed a PET scan after a normal baseline left heart catheterization excluding epicardial CAV. MVD was defined by abnormal PET blood flow. The mean age was 52 ± 14 and MVD was found in 49 patients (53%). No donor risk factors were significantly associated with recipient MVD. Recipients risk factors for MVD included—diabetes mellitus (51% vs. 27%, p = 0.016) and hypertension (78% vs. 49%, p = 0.004) in patients with and without MVD, respectively. In a multivariate model, recipient hypertension and diabetes were the only significant determinants of MVD development (OR = 2.63, 95% CI [1.69–36.98], p = 0.009 and OR 2.1, 95% CI [1.10–15.38], p = 0.035, respectively). In conclusion, MVD was more associated with metabolic risk determinants rather than traditional CAV risk factors.

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PET-CT 定义的心脏移植受者微血管功能障碍和心脏移植血管病风险因素

微血管功能障碍（MVD）被认为是心脏移植物血管病变（CAV）的一种形式，与心脏移植（HTX）后的不良预后密切相关。CAV的传统风险因素是否也适用于MVD，目前尚不清楚。我们回顾性分析了94例HTX受者中与MVD相关的因素，这些受者在基线左心导管检查正常后完成了PET扫描，排除了心外膜CAV。MVD 的定义是 PET 血流异常。平均年龄为 52 ± 14 岁，49 名患者（53%）发现了 MVD。供体风险因素与受体 MVD 无明显关联。有 MVD 和无 MVD 的受体风险因素分别包括糖尿病（51% 对 27%，p = 0.016）和高血压（78% 对 49%，p = 0.004）。在多变量模型中，受体高血压和糖尿病是 MVD 发生的唯一重要决定因素（OR = 2.63，95% CI [1.69-36.98]，p = 0.009 和 OR 2.1，95% CI [1.10-15.38]，p = 0.035）。总之，MVD 与代谢风险决定因素而非传统 CAV 风险因素的关系更大。

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来源期刊

Clinical Transplantation 医学-外科

CiteScore

3.70

自引率

4.80%

发文量

286

审稿时长

2 months

期刊介绍： Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored. Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include: Immunology and immunosuppression; Patient preparation; Social, ethical, and psychological issues; Complications, short- and long-term results; Artificial organs; Donation and preservation of organ and tissue; Translational studies; Advances in tissue typing; Updates on transplant pathology;. Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries. Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.