Myocardial Fibrosis and Prognosis in Heart Transplant Recipients

被引:33
作者
Hughes, Andrew [1 ]
Okasha, Osama [1 ]
Farzaneh-Far, Afshin [2 ]
Kazmirczak, Felipe [1 ]
Nijjar, Prabhjot S. [1 ]
Velangi, Pratik [1 ]
Akcakaya, Mehmet [3 ,4 ]
Martin, Cindy M. [1 ]
Shenoy, Chetan [1 ]
机构
[1] Univ Minnesota, Sch Med, Dept Med, Cardiovasc Div, Minneapolis, MN 55455 USA
[2] Univ Illinois, Dept Med, Sect Cardiol, Chicago, IL USA
[3] Univ Minnesota, Dept Elect & Comp Engn, Minneapolis, MN USA
[4] Univ Minnesota, Ctr Magnet Resonance Res, Minneapolis, MN USA
基金
美国国家卫生研究院;
关键词
fibrosis; heart failure; heart transplantation; magnetic resonance imaging; prognosis; LATE GADOLINIUM ENHANCEMENT; CARDIAC ALLOGRAFT VASCULOPATHY; MAGNETIC-RESONANCE; INTERNATIONAL SOCIETY; DONOR AGE; PROGRESSION; PREVALENCE; DYSFUNCTION; REJECTION; SIROLIMUS;
D O I
10.1161/CIRCIMAGING.119.009060
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
BACKGROUND: Myocardial fibrosis is a well-described histopathologic feature in heart transplant recipients. Whether myocardial fibrosis in heart transplant recipients is independently associated with clinical outcomes is unclear. We sought to determine whether myocardial fibrosis on late gadolinium enhancement cardiovascular magnetic resonance imaging in heart transplant recipients was independently associated with all-cause death or major adverse cardiac outcomes in the long-term. METHODS: Using a cohort of consecutive heart transplant recipients that had cardiovascular magnetic resonance imaging, we determined the prevalence and the patterns of myocardial fibrosis and analyzed associations between myocardial fibrosis and a composite end point of all-cause death or major adverse cardiac events: retransplantation, nonfatal myocardial infarction, coronary revascularization, and heart failure hospitalization. RESULTS: One hundred and fifty-two heart transplant recipients (age, 54 +/- 15 years; 29% women; 5.0 +/- 5.4 years after heart transplantation) were included. Myocardial fibrosis was present in 18% (37% infarct pattern, 41% noninfarct pattern, and 22% both). Its prevalence was positively associated with cardiac allograft vasculopathy grade. With a median follow-up of 2.6 years, myocardial fibrosis was independently associated with all-cause death or major adverse cardiac events (hazard ratio, 2.88; 95% CI, 1.59-5.23; P<0.001) after adjustment for cardiac allograft vasculopathy, history of rejection, time since transplantation, left ventricular ejection fraction, and indexed right ventricular end-diastolic volume. Every 1% increase in myocardial fibrosis was independently associated with a 6% higher hazard for all-cause death or major adverse cardiac events (hazard ratio, 1.06; 95% CI, 1.03-1.09; P<0.001). The addition of myocardial fibrosis variables to models with cardiac allograft vasculopathy, history of rejection, time since transplantation, left ventricular ejection fraction, and indexed right ventricular end-diastolic volume resulted in significant improvements in model fit, suggesting incremental prognostic value. CONCLUSIONS: In heart transplant recipients, myocardial fibrosis is seen on late gadolinium enhancement cardiovascular magnetic resonance imaging in 18%. Both the presence and the extent of myocardial fibrosis are independently associated with the long-term risk of all-cause death or major adverse cardiac events.
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页数:9
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