| Efficacy of augmented immunosuppressive therapy for early vasculopathy in heart transplantation. | |
| | |
MedLine Citation:
|
PMID: 9708469 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
Objectives: The present study was undertaken to prospectively and comparatively evaluate the role of serial myocardial perfusion imaging and coronary angiography for the detection of early vasculopathy in a large patient population and also to determine the short- and long-term efficacy of augmented immunosuppressive therapy in the potential reversal of the early vasculopathy. BACKGROUND: Allograft vasculopathy is the commonest cause of death after the first year of heart transplantation. Anecdotal studies have reported the efficacy of augmented immunosuppressive therapy after early detection of vascular involvement. However, no prospective study has evaluated the feasibility of early detection and treatment of allograft vasculopathy. METHODS: In 76 cardiac allograft recipients, 230 coronary angiographic and 376 scintigraphic studies were performed in a follow-up period of 8 years. Angiography was performed at 1 month and every year after transplantation, and thallium-201 scintigraphy at 1, 3, 6 and 12 months after transplantation and twice a year thereafter. Prospective follow-up of 76 patients showed that 18 developed either angiographic or scintigraphic evidence of coronary vasculopathy. All episodes were treated with 3-day methylprednisolone pulse and antithymocyte globulin. RESULTS: Twenty-two episodes of vasculopathy were diagnosed and treated in these 18 patients. Of these 22 episodes, two were detected only by angiography, seven by both angiography and scintigraphy, four by scintigraphy and histologic evidence of vasculitis and nine episodes only by thallium-201 scintigraphy studies. Angiographic and/or scintigraphic resolution was observed in 15 of the 22 episodes (68%) with augmented immunosuppression. The likelihood of regression was higher when treatment was instituted within the first year of transplantation (92%) than after the first year (40%) (p = 0.033). Eighty percent of patients who responded to follow-up. CONCLUSIONS: The present study suggests that early detection of allograft coronary vasculopathy is feasible with surveillance myocardial perfusion or coronary angiographic studies. When identified early after transplantation, immunosuppressive treatment may result in regression of coronary disease. |
| | |
Authors:
|
R Lamich; M Ballester; V Martí; V Brossa; R Aymat; I Carrió; L Bernà; M Campreciós; M Puig; M Estorch; A Flotats; R Bordes; J Garcia; Augè; J M Padró; J M Caralps; J Narula |
Related Documents
:
|
11666099 - Appropriateness of the use of coronary angiography in a population of patients with isc... 23406079 - Patients with atrial fibrillation and an alternative primary diagnosis in the emergency... 23319459 - The different mechanisms of hypoxic acclimatization and adaptation in lizard phrynoceph... 23538349 - The clinical factors' prediction of increased intradialytic qt dispersion on the electr... 22644719 - Dabigatran and left atrial appendage thrombus. 15180489 - Electron beam tomography as a non invasive method to monitor effectiveness of antiather... 20447539 - The prognostic value of n-terminal pro-b-type natriuretic peptide for death and cardiov... 1392339 - Coronary artery bypass grafting in patients with depressed left ventricular function: o... 2018919 - Effect of electrical stunning frequency on ventricular fibrillation, downgrading and br... |
Publication Detail:
|
Type: Comparative Study; Journal Article |
Journal Detail:
|
Title: Journal of the American College of Cardiology Volume: 32 ISSN: 0735-1097 ISO Abbreviation: J. Am. Coll. Cardiol. Publication Date: 1998 Aug |
Date Detail:
|
Created Date: 1998-09-01 Completed Date: 1998-09-01 Revised Date: 2007-11-15 |
Medline Journal Info:
|
Nlm Unique ID: 8301365 Medline TA: J Am Coll Cardiol Country: UNITED STATES |
Other Details:
|
Languages: eng Pagination: 413-9 Citation Subset: AIM; IM |
Affiliation:
|
Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Adult Anti-Inflammatory Agents / administration & dosage, therapeutic use Antilymphocyte Serum / administration & dosage, therapeutic use Cause of Death Child Coronary Angiography Coronary Circulation / drug effects Coronary Disease / drug therapy, prevention & control*, radiography, radionuclide imaging Evaluation Studies as Topic Feasibility Studies Female Follow-Up Studies Glucocorticoids / administration & dosage, therapeutic use Heart Transplantation* Humans Immunosuppressive Agents / administration & dosage, therapeutic use* Male Methylprednisolone / administration & dosage, therapeutic use Middle Aged Prospective Studies Radiopharmaceuticals / diagnostic use Thallium Radioisotopes / diagnostic use Time Factors Vasculitis / drug therapy, prevention & control, radiography, radionuclide imaging |
| Chemical | |
Reg. No./Substance:
|
0/Anti-Inflammatory Agents; 0/Antilymphocyte Serum; 0/Glucocorticoids; 0/Immunosuppressive Agents; 0/Radiopharmaceuticals; 0/Thallium Radioisotopes; 83-43-2/Methylprednisolone |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Elevated serum concentrations of cardiac troponin T in acute allograft rejection after human heart t...
Next Document: Skeletal muscle response to short endurance training in heart transplant recipients.