Cardiac Allograft Vasculopathy by Intravascular Ultrasound in Heart Transplant Patients
Cardiac Allograft Vasculopathy by Intravascular Ultrasound in Heart Transplant Patients
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DOI：
10.1016/j.jchf.2013.07.002
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发表时间：
2013-10-01
影响因子：
13
通讯作者：
Nicholls, Stephen J.
中科院分区：
文献类型：
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作者：
Kobashigawa, Jon A.;Pauly, Daniel F.;Nicholls, Stephen J.
目的比较依维莫司联合小剂量环孢素与霉酚酸酯（MMF）联合标准剂量环孢素预防心脏移植术后移植心脏血管病变（cardiac allograft vasculopathy，CAV）的疗效。依维莫司已被证明可降低CAV的严重程度和发生率（通过第一年血管内超声（IVUS）测量）。霉酚酸酯与环孢菌素联合应用，也被证明有一个有益的效果，在减缓CAV的进展。方法研究患者是一个预先指定的亚组的553例患者依维莫司与霉酚酸酯在心脏移植：一个随机，多中心试验谁接受心脏移植，并随机依维莫司1.5毫克或霉酚酸酯3克/天。在基线和12个月时进行IVUS。结果依维莫司1.5 mg组平均最大内膜厚度（MIT）较基线增加0.03 mm，明显小于霉酚酸酯组（0.07 mm，P < 0.001）。CAV（定义为MIT从基线至第12个月增加大于0.5 mm）的发生率在依维莫司组为12.5%，在MMF组为26.7%（p = 0.018）。这些结果仍然不考虑性别，年龄，糖尿病状态，供体疾病，和跨脂质categorizes.Conclusions依维莫司是显着更有效的比霉酚酸酯在预防CAV通过IVUS测量心脏移植受者1年后，一个发现，这是保持在一系列的患者亚群。CV手术：移植、心室辅助、心肌病（C）2013年美国心脏病学会基金会
Objectives A pre-planned substudy of a larger multicenter randomized trial was undertaken to compare the efficacy of everolimus with reduced-dose cyclosporine in the prevention of cardiac allograft vasculopathy (CAV) after heart transplantation to that of mycophenolate mofetil (MMF) with standard-dose cyclosporine.Background CAV is a major cause of long-term mortality following heart transplantation. Everolimus has been shown to reduce the severity and incidence of CAV as measured by first year intravascular ultrasound (IVUS). MMF, in combination with cyclosporine, has also been shown to have a beneficial effect in slowing the progression of CAV.Methods Study patients were a pre-specified subgroup of the 553-patient Everolimus versus mycophenolate mofetil in heart transplantation: a randomized, multicenter trial who underwent heart transplantation and were randomized to everolimus 1.5 mg or MMF 3 g/day. IVUS was performed at baseline and at 12 months. Evaluable IVUS data were available in 189 patients (34.6%).Results Increase in average maximal intimal thickness (MIT) from baseline to month 12 was significantly smaller in the everolimus 1.5 mg group compared with the MMF group (0.03 mm vs. 0.07 mm, p < 0.001). The incidence of CAV, defined as an increase in MIT from baseline to month 12 of greater than 0.5 mm, was 12.5% with everolimus versus 26.7% with MMF (p = 0.018). These findings remained irrespective of sex, age, diabetic status, donor disease, and across lipid categories.Conclusions Everolimus was significantly more efficacious than MMF in preventing CAV as measured by IVUS among heart-transplant recipients after 1 year, a finding, which was maintained in a range of patient subpopulations. CV surgery: transplantation, ventricular assistance, cardiomyopathy (C) 2013 by the American College of Cardiology Foundation