Department of Radiology, Cardiothoracic Imaging Division, Clínica Universidad de Navarra, Avenida Pio XII, 36, Pamplona 31008, Spain.
Department of Radiology, Cardiothoracic Imaging Division, Clínica Universidad de Navarra, Madrid, Spain.
AJR Am J Roentgenol. 2021 May;216(5):1216-1221. doi: 10.2214/AJR.20.23535. Epub 2021 Feb 24.
This study aimed to evaluate the long-term prognostic value of coronary CTA (CCTA) in heart transplant recipients. The records of 114 patients who had undergone a heart transplant (mean age, 61.7 ± 11.1 [SD] years; 83.3% men) and who underwent CCTA for the surveillance of coronary allograft vasculopathy (CAV) from June 2007 to December 2017 were retrospectively evaluated for the occurrence of major adverse cardiovascular events (MACEs) (cardiac death, nonfatal myocardial infarction, unstable angina requiring hospitalization, coronary revascularization, cardiac arrhythmias, stroke, and retransplant). Patients were classified according to the presence of nonobstructive CAV (lumen reduction < 50%) or obstructive disease (lumen reduction ≥ 50%) and using a coronary segment involvement score (SIS). Differences in MACE rate between groups were compared. Obstructive CAV was observed in 12 heart transplant recipients (10.5%). During a mean follow-up of 67.5 ± 41.4 months the overall rates of MACE were 50% and 14.7% in patients with obstructive and nonobstructive CAV, respectively ( < .05), resulting in an odds ratio for MACE of 6 (95% CI, 1.7-21.2). Comparison of event-free survival showed a hazard ratio (HR) of 5 (95% CI, 1.95-13; =. 004) for patients with obstructive disease. The presence of four or more stenotic coronary segments (SIS ≥ 4) was associated with a higher rate of events (HR, 3.46; 95% CI, 1.46-8.23). In patients who have undergone a heart transplant, CCTA offers a significant long-term prognostic impact on the prediction of MACEs.
本研究旨在评估心脏移植受者冠状动脉 CTA（CCTA）的长期预后价值。回顾性分析了 2007 年 6 月至 2017 年 12 月期间因冠状动脉移植血管病（CAV）监测而行 CCTA 的 114 例心脏移植患者（平均年龄 61.7 ± 11.1 [SD] 岁；83.3%为男性）的记录，以评估主要不良心血管事件（MACE）（心脏死亡、非致死性心肌梗死、需要住院治疗的不稳定型心绞痛、冠状动脉血运重建、心律失常、卒中和再次移植）的发生情况。根据非阻塞性 CAV（管腔狭窄<50%）或阻塞性疾病（管腔狭窄≥50%）以及冠状动脉节段受累评分（SIS）对患者进行分类。比较两组间 MACE 发生率的差异。12 例心脏移植受者（10.5%）存在阻塞性 CAV。在平均 67.5 ± 41.4 个月的随访期间，阻塞性和非阻塞性 CAV 患者的 MACE 总发生率分别为 50%和 14.7%（<0.05），MACE 的优势比为 6（95%CI，1.7-21.2）。无事件生存比较显示，阻塞性疾病患者的危险比（HR）为 5（95%CI，1.95-13；=0.004）。存在 4 个或更多狭窄冠状动脉节段（SIS≥4）与更高的事件发生率相关（HR，3.46；95%CI，1.46-8.23）。在心脏移植受者中，CCTA 对预测 MACE 具有显著的长期预后影响。
