From the Department of Cardiology, Ankara Hospital, Başkent University Faculty of Medicine, Ankara, Turkey.
Exp Clin Transplant. 2020 Jan;18(Suppl 1):99-104. doi: 10.6002/ect.TOND-TDTD2019.P37.
Posttransplant cardiac allograft vasculo-pathy affects long-term survival after heart transplant. Because cardiac transplant recipients do not feel angina pectoris as a result of denervation of the transplanted heart graft, early diagnosis is difficult. The Gensini score, a widely used and simple scoring system, can determine the severity of coronary artery disease by angiography. Although this system has been widely used to evaluate natural coronary atherosclerosis, its use in heart transplant recipients has not been studied. Here, we evaluated cardiac allograft vasculo-pathy using the Gensini score.
We retrospectively analyzed 105 heart transplant patients seen between February 2004 and April 2018, including their immunosuppressive therapies. The Gensini score was calculated to determine severity score for each coronary stenosis according to degree of luminal narrowing and location.
Of 105 heart transplant patients, 21 were diagnosed with cardiac allograft vasculopathy. Most patients received tacrolimus, prednisolone, and mycophenolate mofetil as standard therapy. Of 63 included patients, 21 (33.3%) showed cardiac allograft vasculopathy on coronary angiography. In accordance with the International Society of Heart and Lung Transplantation rating system, 42 of 63 patients (66.6%) were rated as 0 (no detectable angiographic lesions). Mean Gensini score was 34.8 ± 26. In the 21 patients with cardiac allograft vasculopathy, Gensini score showed mild cardiac allograft vas-culopathy (score ≤ 10) in 8 patients (38%), moderate (score > 10 and ≤ 40) in 6 patients (28.5%), and severe (score > 40) in 7 patients (33.3%). Angiographic coronary artery disease burden using Gensini was strongly correlated with cardiac allograft vasculopathy severity.
The Gensini score could provide valid assessment of cardiac allograft vasculopathy burden for use in clinical practice. However, more research is needed to identify and treat cardiac allograft vasculopathy for successful long-term survival of heart transplant patients.
移植心脏后的心脏同种异体血管病影响长期存活。由于移植心脏移植物的去神经支配，心脏移植受者不会感到心绞痛，因此早期诊断较为困难。Gensini 评分是一种广泛使用的简单评分系统，通过血管造影可以确定冠状动脉疾病的严重程度。尽管该系统已广泛用于评估自然冠状动脉粥样硬化，但尚未研究其在心脏移植受者中的应用。在这里，我们使用 Gensini 评分评估心脏同种异体血管病。
我们回顾性分析了 2004 年 2 月至 2018 年 4 月间就诊的 105 例心脏移植患者，包括他们的免疫抑制治疗。根据管腔狭窄程度和位置，计算 Gensini 评分以确定每个冠状动脉狭窄的严重程度评分。
在 105 例心脏移植患者中，21 例诊断为心脏同种异体血管病。大多数患者接受他克莫司、泼尼松和吗替麦考酚酯作为标准治疗。在纳入的 63 例患者中，21 例（33.3%）在冠状动脉造影上显示心脏同种异体血管病。根据国际心肺移植学会的评级系统，63 例患者中的 42 例（66.6%）被评为 0（无明显血管造影病变）。平均 Gensini 评分为 34.8±26。在 21 例心脏同种异体血管病患者中，8 例（38%）为轻度心脏同种异体血管病（评分≤10），6 例（28.5%）为中度（评分>10 且≤40），7 例（33.3%）为重度（评分>40）。使用 Gensini 的冠状动脉疾病负担与心脏同种异体血管病严重程度呈强相关。
Gensini 评分可以为心脏同种异体血管病负担提供有效的评估，用于临床实践。然而，需要进一步研究以识别和治疗心脏同种异体血管病，从而成功实现心脏移植受者的长期存活。
