Coronary Artery Test Useful as Prognostic Tool in Heart Transplantation

Newswise — A new UCLA study finds that an innovative diagnostic tool can help identify a life threatening condition that affects the long-term outcome of heart transplant recipients.

The landmark study, published in the May 3 issue of the Journal of the American College of Cardiology, found a breakthrough in the understanding of a serious complication that is a major impediment to long-term survival in heart transplant recipients.

The authors described the use of an innovative technique called IntraVascular UltraSound, which correlates the long-term consequences of pathological changes in coronary blood vessels with risk for further coronary events and, ultimately, survival.

This pathological change, called cardiac allograft vasculopathy (CAV), is an accentuated process along the vessel walls of heart transplant recipients, and it is estimated that more than 50 percent of all heart transplant recipients suffer from this condition.

The IntraVascular UltraSound technique used by the study's lead author, Dr. Jon Kobashigawa, medical director of the UCLA Heart Transplant program and professor of cardiology at the David Geffen School of Medicine at UCLA, along with his UCLA colleagues and collaborators from four other U.S. institutions, allowed them to both identify the severity of the CAV problem in heart transplant patients and determine the relationship between severity and cardiac events and survival.

In the present study, 125 heart transplant patients had their heart blood vessels examined by IntraVascular UltraSound at the time of heart transplantation, as well as at the end of one year and five years. Patients with abnormal blood vessel thickening (CAV) at the end of one year had a three times greater risk of death and major cardiovascular events over the five-year study.

"This is a very exciting new development in transplant medicine," Kobashigawa said. "The validation of this tool as a sensitive predictor of coronary events due to CAV will allow us to explore ways of preventing this disease."

One such intervention is a proliferation signal inhibitor drug (Certican, Novartis Pharma) which, in a previous study using the same IntraVascular UltraSound technique, demonstrated a highly significant 43 percent reduction in CAV when compared to standard therapy in heart transplant recipients.

This study was supported by an unrestricted grant from Novartis Pharmaceuticals. Kobashigawa is an advisory board member for Novartis Pharmaceuticals and has received speaker honorariums from the company.