Late Changes in Maximal Intimal Thickness after Heart Transplant: Prognostic Implications and Risk Factors

Purpose Intravascular ultrasound (IVUS) provides unique prognostic information on allograft vasculopathy progression by detecting increase in maximal intimal thickness (MIT) during the first post-heart transplant (HT) year. Later changes in coronary morphology, their prognostic relevance, and risk factors are however unexplored. Methods and Materials We investigated whether changes in coronary morphology assessed in patients receiving serial IVUS at 1 and 5 years after HT predicted fatal and non-fatal cardiovascular (CV) events. We additionally analyzed the impact of metabolic risk factors on changes in IVUS measurements. Results 107 consecutive patients receiving HT between 1999 and 2007 entered the study. During the 11 years of follow-up, incidence of CV death was 8±3% and of CV events was 26±6%. Between year 1 and 5, MIT and intimal volume increased, lumen volume decreased (P Figure ). Among the metabolic parameters, increasing triglycerides and HDL-cholesterol ≤65mg/dl predicted MIT increase ≥ 0.35 mm (P≤0.05). Conclusions This study provides the first suggestive evidence that MIT increase represent a relevant prognostic marker also after the first year after HT. In addition, the finding that clinically relevant MIT is predicted by lipid pattern typical of insulin resistance, provide a strong rationale supporting aggressive therapeutic interventions against metabolic abnormalities mid and long-term after HT.