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Cecere A, Kerkhof P, Angelini A, Gambino A, Fraiese A, Bottio T, Osto E, Famoso G, Fedrigo M, Giacomin E, Montisci R, Iliceto S, Gerosa G, Tona F. Multiparametric evaluation of coronary flow predicts long-term outcome in heart transplantation: from coronary flow velocity reserve to its newly introduced companion. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Coronary microvascular dysfunction (CMD) leads to a worse prognosis in heart transplantation (HT) patients. Coronary flow velocity reserve (CFVR) estimates the physiologic impact of allograft disease on the coronary circulation.
Purpose
Our aim was to determine the prognostic role of CFVR and its companion (CFVRC) on long-term survival of HT patients with a follow-up of 28 years.
Methods
134 HT patients, surviving at least 5 years after HT, with normal systolic ventricular function and no evidence of angiographic allograft vasculopathy or symptoms/signs of rejection were included. The enrolled population underwent echocardiographic evaluation of microvascular function by the assessment of both the ratio of hyperemic to rest diastolic peak velocity (DPVh and DPVr). These measurements yield CFVR and its associated companion, defined as CFVRC = √{(DPVr)2 + (DPVh)2}, as well as basal and hyperemic coronary microvascular resistance (BMR and HMR). A CFVR≤2.5 was considered abnormal; the median value of DPVh (75 cm/s) and CFVRC (80 cm/s) were utilized to dichotomize the population.
Results
Based on CFVR and DPVh, HT patients can be assigned to four groups: group 1 (n=32), discordant with preserved CFVR (3.1±0.4); group 2 (n=60), concordant with preserved CFVR (3.4±0.5); group 3 (n=31), concordant with impaired CFVR (1.8±0.3) and group 4 (n=11), discordant with impaired CFVR (2.0±0.2). Survival for each patient group is presented in the Figure (panel A). Specifically, survival was similar in group 1 when compared to group 3 (p=0.8), but significantly lower when compared to group 2 (p=0.03). Therefore, a normal CFVR (>2.5) may not be able to predict the unfavourable long-term outcome. CFVR in fact is an incomplete dimensionless ratio; if the paired velocities are low with high BMR and HMR (group 1), the use of CFVR alone may miss some events, that are yet captured by CFVRC. Differences between survivors and no survivors are presented in the Table. At multivariable survival analysis, CMD, DPVh<75 cm/s, CFVRC<80 cm/s were independent predictors of mortality in HT patients. Consequently, we evaluated the added role of the CMD, DPVh<75 cm/s and CFVRC<80 cm/s to prognostic models including the clinical (Figure, panel B) predictors of mortality. The inclusion of CFVRC<80 cm/s to model with clinical predictors of mortality permitted better prediction of survival in HT patients, compared to only adding CMD or DPVh<75 cm/s.
Conclusions
This study is the first to demonstrate that the CFVR alone, even representing a determinant of survival in long-term HT patients, is not sufficient to completely predict long-term survival in HT patients. In comparison to CMD and DPVh, the CFVRC provides a significant improvement in survival prediction in long-term HT patients. Thus, the proposed multiparametric approach offers a more comprehensive evaluation of prognosis in HT patients, just by applying available data without the need to perform additional measurements.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- A Cecere
- University of Padua, Department of Cardiac, Thoracic and Vascular Sciences, Padova, Italy
| | - P.L.M Kerkhof
- VU University Medical Center, Radiology and Nuclear Medicine, Amsterdam, Netherlands (The)
| | - A Angelini
- University of Padova, Cardiovascular Pathology Unit, Department of Cardiac, Thoracic and Vascular Sciences, Padua, Italy
| | - A Gambino
- University of Padua, Division of Cardiac Surgery, Padova, Italy
| | - A Fraiese
- University of Padua, Division of Cardiac Surgery, Padova, Italy
| | - T Bottio
- University of Padua, Division of Cardiac Surgery, Padova, Italy
| | - E Osto
- University Heart Center, Cardiology Department, Zurich, Switzerland
| | - G Famoso
- University of Padua, Department of Cardiac, Thoracic and Vascular Sciences, Padova, Italy
| | - M Fedrigo
- University of Padova, Cardiovascular Pathology Unit, Department of Cardiac, Thoracic and Vascular Sciences, Padua, Italy
| | - E Giacomin
- University of Padua, Department of Cardiac, Thoracic and Vascular Sciences, Padova, Italy
| | - R Montisci
- University of Cagliari, Clinical Cardiology, Department of Medical Science and Public Health, Cagliari, Italy
| | - S Iliceto
- University of Padua, Department of Cardiac, Thoracic and Vascular Sciences, Padova, Italy
| | - G Gerosa
- University of Padua, Division of Cardiac Surgery, Padova, Italy
| | - F Tona
- University of Padua, Department of Cardiac, Thoracic and Vascular Sciences, Padova, Italy
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Cecere A, Kerkhof P, Angelini A, Gambino A, Fraiese A, Bottio T, Osto E, Famoso G, Fedrigo M, Giacomin E, Montisci R, Iliceto S, Gerosa G, Tona F. Coronary flow evaluation in heart transplant patients compared to healthy controls documents the inadequacy of the coronary flow velocity reserve metric. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Coronary microvasculopathy has impact on prognosis in heart transplantation (HT). Distinct contributions by functional or structural alterations of coronary microcirculation in HT and their prognostic role have not been fully elucidated.
Purpose
We aimed to identify the mechanisms of coronary microvascular impairment in HT and their possible prognostic implications by applying a comprehensive analysis in a comparative study.
Methods
Included were 134 patients, surviving at least 5 years, with normal systolic function and no evidence of allograft vasculopathy or symptoms/signs of rejection. To permit comparison, 50 healthy volunteers without cardiovascular diseases, and matched for age and sex, served as controls. All underwent echocardiographic evaluation of microvascular function by the assessment of rest and hyperemic diastolic peak blood velocity (DPVr and DPVh). These paired data enable calculation of coronary flow velocity reserve (CFVR) and its inherent companion that is based on the quadratic mean: CFVRC = √{(DPVr)2 + (DPVh)2}. Additionally, basal and hyperemic coronary microvascular resistance (BMR and HMR) were estimated. A CFVR ≤2.5 was considered abnormal; the median value of DPVh (75 cm/s) and CFVRC (80 cm/s) were selected as cut-offs to classify patients.
Results
HT patients can be assigned to four groups, based on their CFVR and DPVh (Figure A): group 1 (n=32), discordant with preserved CFVR (3.1±0.4); group 2 (n=60), concordant with preserved CFVR (3.4±0.5); group 3 (n=31), concordant with impaired CFVR (1.8±0.3) and group 4 (n=11), discordant with impaired CFVR (2.0±0.2). Group 3 represents the structural microvascular remodeling with high HMR, while group 4 represents the functional remodeling with low BMR. Intriguingly, group 1 showed lower DPVr (p<0.0001) and lower DPVh (p<0.0001) than controls (Figure B, upper panel) with lower CFVR (p<0.0001), even if normal, and lower CFVRC (p<0.0001) than controls (Figure B, lower panel). Moreover, both BMR and HMR were higher in group 1 than in controls (5.3±1 vs 4.4±1.2, p=0.001 and 1.5±0.3 vs 1.1±0.2, p<0.0001, respectively), suggesting structural microvascular remodeling. Conversely, group 2 was comparable with controls (Figure B). Clinical characteristics of the different groups are shown in the Table. 13/32 (40.6%) patients in group 1 died in a follow up of 28 years and mortality rate was comparable to group 3 (14/31, 45.2%). However, CFVRC was <80 cm/s in all 13 deaths in group 1, yet being characterized by preserved CFVR (Figure C).
Conclusions
A normal CFVR could hide detection of microvascular damage with high flow resistance and low flow velocities at rest. This microvasculopathy seems to be secondary to factors unrelated to HT (i.e., less rejections and more often diabetes). Being a dimensionless ratio, CFVR may miss some deaths, yet captured by CFVRC. Thus, the combined use of CFVR and CFVRC provides more complete clinical information on coronary microvasculopathy in HT.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- A Cecere
- University of Padua, Department of Cardiac, Thoracic and Vascular Sciences, Padova, Italy
| | - P.L.M Kerkhof
- VU University Medical Center, Radiology and Nuclear Medicine, Amsterdam, Netherlands (The)
| | - A Angelini
- University of Padova, Cardiovascular Pathology Unit, Department of Cardiac, Thoracic and Vascular Sciences, Padua, Italy
| | - A Gambino
- University of Padua, Division of Cardiac Surgery, Padova, Italy
| | - A Fraiese
- University of Padua, Division of Cardiac Surgery, Padova, Italy
| | - T Bottio
- University of Padua, Division of Cardiac Surgery, Padova, Italy
| | - E Osto
- University Heart Center, Cardiology Department, Zurich, Switzerland
| | - G Famoso
- University of Padua, Department of Cardiac, Thoracic and Vascular Sciences, Padova, Italy
| | - M Fedrigo
- University of Padova, Cardiovascular Pathology Unit, Department of Cardiac, Thoracic and Vascular Sciences, Padua, Italy
| | - E Giacomin
- University of Padua, Department of Cardiac, Thoracic and Vascular Sciences, Padova, Italy
| | - R Montisci
- University of Cagliari, Clinical Cardiology, Department of Medical Science and Public Health, Cagliari, Italy
| | - S Iliceto
- University of Padua, Department of Cardiac, Thoracic and Vascular Sciences, Padova, Italy
| | - G Gerosa
- University of Padua, Division of Cardiac Surgery, Padova, Italy
| | - F Tona
- University of Padua, Department of Cardiac, Thoracic and Vascular Sciences, Padova, Italy
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Iversen L, Eidsmo L, Austad J, Rie M, Osmancevic A, Skov L, Talme T, Bachmann I, Kerkhof P, Stahle M, Banerjee R, Oliver J, Fasth A, Frueh J. Secukinumab treatment in new‐onset psoriasis: aiming to understand the potential for disease modification – rationale and design of the randomized, multicenter
STEPI
n study. J Eur Acad Dermatol Venereol 2018; 32:1930-1939. [DOI: 10.1111/jdv.14979] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 03/06/2018] [Indexed: 12/14/2022]
Affiliation(s)
- L. Iversen
- Aarhus University Hospital Aarhus Denmark
| | - L. Eidsmo
- Department of Dermatology Karolinska University Hospital Stockholm Sweden
- Department of Medicine Solna Karolinska Institutet Stockholm Sweden
| | - J. Austad
- Oslo University Hospital Oslo Norway
| | - M. Rie
- Academisch Medisch Centrum Amsterdam The Netherlands
| | - A. Osmancevic
- Department of Dermatology Sahlgrenska University Hospital Gothenburg Sweden
| | - L. Skov
- Herlev and Gentofte Hospital University of Copenhagen Copenhagen Denmark
| | - T. Talme
- Department of Dermatology Karolinska University Hospital Stockholm Sweden
- Department of Medicine Solna Karolinska Institutet Stockholm Sweden
| | | | - P. Kerkhof
- Radboud University Nijmegen Medical Centre Nijmegen The Netherlands
| | - M. Stahle
- Department of Dermatology Karolinska University Hospital Stockholm Sweden
- Department of Medicine Solna Karolinska Institutet Stockholm Sweden
| | - R. Banerjee
- Novartis Healthcare Private Limited Hyderabad India
| | - J. Oliver
- Novartis Pharma AG Basel Switzerland
| | | | - J. Frueh
- Novartis Pharma AG Basel Switzerland
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Gordon K, Gottlieb A, Langely R, Kerkhof P, Belasco K, Sundaram M, Okun M, Serra L. Adalimumab retreatment successfully restores clinical response and health‐related quality of life in patients with moderate to severe psoriasis who undergo therapy interruption. J Eur Acad Dermatol Venereol 2014; 29:767-76. [DOI: 10.1111/jdv.12677] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 07/03/2014] [Indexed: 11/29/2022]
Affiliation(s)
- K.B. Gordon
- Feinberg School of Medicine Northwestern University Chicago IL USA
| | | | | | - P. Kerkhof
- Radboud University Medical Centre Nijmegen The Netherlands
| | | | | | - M. Okun
- AbbVie Inc. North Chicago IL USA
| | - L. Serra
- AbbVie Inc. North Chicago IL USA
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Paul C, Puig L, Kragballe K, Luger T, Lambert J, Chimenti S, Girolomoni G, Nicolas J, Rizova E, Lavie F, Mistry S, Bergmans P, Barker J, Reich K, Adamski Z, Altomare G, Aricò M, Aste N, Aubin F, Augustin M, Ayala F, Bachelez H, Baran E, Barker J, Belinchón I, Berbis P, Bernengo M, Bessis D, Beylot‐Barry M, Bordas Orpinell F, Burden D, Bylaite M, Cambazard F, Carazo S, Carrascosa J, Carretero G, Cerio R, Chimenti S, David M, Duval‐Modeste A, Eedy D, Estebaranz L, Filipe P, Flytström I, Fonseca E, Gamanya R, Ghislain P, Giannetti A, Girolomoni G, Gospodinov D, Griffiths C, Grob J, Guillet G, Hernanz Hermosa J, Hoffmann M, Ioannidis D, Jacobi A, Jemec G, Kadurina M, Kaszuba K, Katsambas A, Kemeny L, Kerkhof P, Kragballe K, Kuzmina N, Lambert K, Lázaro P, Lotti T, Luger T, Matz H, Modiano P, Moessner R, Moreno D, Moreno Jímenez J, Mørk N, Mrowietz U, Murphy R, Nicolas J, Nikkels A, Oliveira H, Ormerod A, Ortonne J, Parodi A, Pasternack R, Paul C, Pec J, Peserico A, Philipp S, Piquet L, Plantin P, Puig L, Reich K, Reményik E, Riedl E, Röcken M, Rustin M, Saari S, Saiag P, Salmhofer W, Schadendorf D, Sebastian M, Simaljakova M, Simon J, Spirén A, Stalder J, Stavrianeas N, Sticherling M, Ternowitz T, Thaci D, Thio B, Uhlig D, Valiukeviciene S, Vanaclocha Sebastián F, Wozel G. Transition to ustekinumab in patients with moderate‐to‐severe psoriasis and inadequate response to methotrexate: a randomized clinical trial (
TRANSIT
). Br J Dermatol 2014; 170:425-34. [DOI: 10.1111/bjd.12646] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2013] [Indexed: 12/25/2022]
Affiliation(s)
- C. Paul
- Hôpital Larrey Service de Dermatologie Toulouse cedex 9 31059 France
| | - L. Puig
- Department of Dermatology Hospital de la Santa Creu i Sant Pau Universitat Autònoma de Barcelona 08025 Barcelona Spain
| | - K. Kragballe
- Department of Dermatology Århus University Hospital Århus Sygehus 8000 Århus Denmark
| | - T. Luger
- Department of Dermatology University of Münster D‐48149 Münster Germany
| | - J. Lambert
- Department of Dermatology Ghent University 9000 Ghent Belgium
| | - S. Chimenti
- Policlinico Universitario Tor Vergata Clinica Dermatologica 00133 Rome Italy
| | - G. Girolomoni
- Clinica Dermatologica University of Verona 37126 Verona Italy
| | | | - E. Rizova
- Janssen‐Cilag 1 rue Camille Desmoulins TSA 91003 92787 Issy les Moulineaux, Cedex 9 France
| | - F. Lavie
- Janssen‐Cilag 1 rue Camille Desmoulins TSA 91003 92787 Issy les Moulineaux, Cedex 9 France
| | - S. Mistry
- Janssen 50‐100 Holmers Farm Way High Wycombe Bucks HP12 4EG U.K
| | - P. Bergmans
- Janssen‐Cilag B.V. Postbus 90240 5000 LT Tilburg the Netherlands
| | - J. Barker
- St John's Institute of Dermatology King's College London SE1 9RT U.K
| | - K. Reich
- Dermatologikum Hamburg Stephansplatz 5 20354 Hamburg Germany
- Georg‐August‐University Göttingen Germany
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Pagani M, Mirsky I, Baig H, Manders WT, Kerkhof P, Vatner SF. Effects of age on aortic pressure-diameter and elastic stiffness-stress relationships in unanesthetized sheep. Circ Res 1979; 44:420-9. [PMID: 104801 DOI: 10.1161/01.res.44.3.420] [Citation(s) in RCA: 75] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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