Park Hyun Woong, Ozcan Ilke, Toya Takumi, Ahmad Ali, Kanaji Yoshihisa, Kushwaha Sudhir S, Lerman Lilach O, Lerman Amir
Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA; Department of Cardiology in Internal Medicine, Chungnam National University Sejong Hospital, Chungnam National University College of Medicine, Sejong, South Korea.
Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA.
Int J Cardiol. 2023 Jan 1;370:167-174. doi: 10.1016/j.ijcard.2022.10.159. Epub 2022 Oct 29.
Pulse pressure (PP) has been linked to an increased risk of extent of coronary atherosclerosis and cardiovascular events. This study aimed to investigate the contribution of aortic PP on cardiac allograft vasculopathy (CAV) progression, and cardiovascular events after heart transplantation (HTx).
A total of 330 HTx patients (mean age 49 ± 25 years, 70.0% male) undergoing routine serial coronary intravascular ultrasound (IVUS) studies and had invasive aortic PP were enrolled. The median time from HTx to first IVUS was 13.6 months. CAV progression was assessed by IVUS as the changes (Δ) in plaque volume divided by the segment length (PV/SL), adjusted for the time between IVUS (median, 3.99 years; interquartile range, 1.99-7.20 years), and was defined as ΔPV/SL ≥0.50 mm/mm/year. Major adverse cardiovascular event (MACE) was defined as any incidence of mortality, myocardial infarction, coronary revascularization, heart failure hospitalization, or re-transplantation.
Recipient age, recipient sex, and renal dysfunction were independent determinant of high aortic PP (≥ 50 mmHg). High aortic PP was an independent determinant of CAV progression [odds ratio, 1.72; 95% confidence interval (CI), 1.01-2.93; p = 0.045]. Both high aortic PP (HR 1.46, 95% CI 1.01-2.11, p = 0.044) and high baseline CAV grade on angiogram (≥1, HR 1.50, 95% CI 1.03-2.21, p = 0.037) were independently associated with MACEs over 12 years.
In post-HTx patients, high aortic PP was significantly associated with plaque progression. Both aortic PP and CAV grade are independently associated with MACE during long-term follow-up. These findings suggest that arterial stiffness and CAV can be important predictors of MACEs.
脉压（PP）与冠状动脉粥样硬化范围扩大及心血管事件风险增加有关。本研究旨在探讨主动脉脉压对心脏移植血管病变（CAV）进展及心脏移植（HTx）后心血管事件的影响。
共纳入330例接受常规系列冠状动脉血管内超声（IVUS）检查且有创测量主动脉脉压的HTx患者（平均年龄49±25岁，70.0%为男性）。从HTx到首次IVUS检查的中位时间为13.6个月。通过IVUS评估CAV进展，以斑块体积变化（Δ）除以节段长度（PV/SL）表示，并根据IVUS检查间隔时间（中位时间为3.99年；四分位间距为1.99 - 7.20年）进行调整，定义为ΔPV/SL≥0.50 mm/mm/年。主要不良心血管事件（MACE）定义为任何死亡、心肌梗死、冠状动脉血运重建、心力衰竭住院或再次移植事件。
受者年龄、受者性别和肾功能不全是高主动脉脉压（≥50 mmHg）的独立决定因素。高主动脉脉压是CAV进展的独立决定因素[比值比，1.72；95%置信区间（CI），1.01 - 2.93；p = 0.045]。高主动脉脉压（HR 1.46，95% CI 1.01 - 2.11，p = 0.044）和血管造影时较高的基线CAV分级（≥1，HR 1.50，95% CI 1.03 - 2.21，p = 0.037）均与12年内的MACE独立相关。
在HTx术后患者中，高主动脉脉压与斑块进展显著相关。在长期随访中，主动脉脉压和CAV分级均与MACE独立相关。这些发现表明动脉僵硬度和CAV可能是MACE的重要预测因素。
