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Wall C, Weir-McCall J, Tweed K, Hoole SP, Gopalan D, Huang Y, Corovic A, Peverelli M, Dey D, Bennett MR, Rudd JHF, Kydd A, Bhagra S, Tarkin JM. CT pericoronary adipose tissue density predicts coronary allograft vasculopathy and adverse clinical outcomes after cardiac transplantation. Eur Heart J Cardiovasc Imaging 2024:jeae069. [PMID: 38493483 DOI: 10.1093/ehjci/jeae069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 02/26/2024] [Indexed: 03/19/2024] Open
Abstract
AIMS To assess pericoronary adipose tissue (PCAT) density on Coronary Computed Tomography Angiography (CCTA) as a marker of inflammatory disease activity in coronary allograft vasculopathy (CAV). METHODS AND RESULTS PCAT density, lesion volumes, and total vessel volume-to-myocardial mass ratio (V/M) were retrospectively measured in 126 CCTAs from 94 heart transplant patients (mean age 49 [SD 14.5] years, 40% female) who underwent imaging between 2010 to 2021; age and sex-matched controls; and patients with atherosclerosis. PCAT density was higher in transplant patients with CAV (n = 40; -73.0 HU [SD 9.3]) than without CAV (n = 86; -77.9 HU [SD 8.2]), and controls (n = 12; -86.2 HU [SD 5.4]), p < 0.01 for both. Unlike patients with atherosclerotic coronary artery disease (n = 32), CAV lesions were predominantly non-calcified, comprised of mostly fibrous or fibrofatty tissue. V/M was lower in patients with CAV than without (32.4 mm3/g [SD 9.7] vs. 41.4 mm3/g [SD 12.3], p < 0.0001). PCAT density and V/M improved the ability to predict CAV from AUC 0.75 to 0.85 when added to donor age and donor hypertension status (p < 0.0001). PCAT density above -66 HU was associated with a greater incidence of all-cause mortality (OR 18.0 [95%CI 3.25-99.6], p < 0.01) and the composite endpoint of death, CAV progression, acute rejection, and coronary revascularization (OR 7.47 [95%CI 1.8-31.6], p = 0.01) over 5.3 (SD 2.1) years. CONCLUSIONS Heart transplant patients with CAV have higher PCAT density and lower V/M than those without. Increased PCAT density is associated with adverse clinical outcomes. These CCTA metrics could be useful for diagnosis and monitoring of CAV severity.
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Affiliation(s)
- Christopher Wall
- Section of Cardiorespiratory Medicine, University of Cambridge, Cambridge, UK
| | - Jonathan Weir-McCall
- Department of Radiology, University of Cambridge, Cambridge, UK
- Department of Radiology, Royal Papworth Hospital, Cambridge, UK
| | - Katharine Tweed
- Department of Radiology, Royal Papworth Hospital, Cambridge, UK
| | - Stephen P Hoole
- Department of Cardiology, Royal Papworth Hospital, Cambridge, UK
| | - Deepa Gopalan
- Department of Radiology, Cambridge University Hospitals NHS Trust, Cambridge, UK
- Department of Radiology, Imperial College Healthcare NHS Trust, London, UK
| | - Yuan Huang
- Section of Cardiorespiratory Medicine, University of Cambridge, Cambridge, UK
| | - Andrej Corovic
- Section of Cardiorespiratory Medicine, University of Cambridge, Cambridge, UK
| | - Marta Peverelli
- Section of Cardiorespiratory Medicine, University of Cambridge, Cambridge, UK
| | - Damini Dey
- Departments of Biomedical Sciences and Medicine, Cedars-Sinai Medical Center, Biomedical Imaging Research Institute, Los Angeles, California
| | - Martin R Bennett
- Section of Cardiorespiratory Medicine, University of Cambridge, Cambridge, UK
| | - James H F Rudd
- Section of Cardiorespiratory Medicine, University of Cambridge, Cambridge, UK
| | - Anna Kydd
- Transplant Unit, Royal Papworth Hospital, Cambridge, UK
| | - Sai Bhagra
- Transplant Unit, Royal Papworth Hospital, Cambridge, UK
| | - Jason M Tarkin
- Section of Cardiorespiratory Medicine, University of Cambridge, Cambridge, UK
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Coromilas E, Que-Xu EC, Moore D, Kato TS, Wu C, Ji R, Givens R, Jorde UP, Takayama H, Naka Y, George I, Mancini D, Schulze PC. Dynamics and prognostic role of galectin-3 in patients with advanced heart failure, during left ventricular assist device support and following heart transplantation. BMC Cardiovasc Disord 2016; 16:138. [PMID: 27301475 PMCID: PMC4906704 DOI: 10.1186/s12872-016-0298-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 05/23/2016] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Galectin-3 is a marker of myocardial inflammation and fibrosis shown to correlate with morbidity and mortality in heart failure (HF). We examined the utility of galectin-3 as a marker of the severity of HF, the response of galectin-3 levels to ventricular assist device (LVAD) implantation or heart transplantation (HTx), and its use as a prognostic indicator. METHODS Plasma galectin-3 was measured using a commercially available ELISA assay in patients with stable HF (n = 55), severe HF (n = 63), at 3 (n = 17) and 6 (n = 14) months post-LVAD and at LVAD explantation (n = 23), patients following HTx (n = 85) and healthy controls (n = 30). RESULTS Galectin-3 levels increase with the severity of HF (severe HF: 28.2 ± 14, stable HF: 19.7 ± 13, p = 0.001; controls: 13.2 ± 9 ng/ml, p = 0.02 versus stable HF). Following LVAD implantation, galectin-3 levels are initially lower (3 months: 23.7 ± 9, 6 months: 21.7 ± 9 versus 29.2 ± 14 ng/ml implantation; p = NS) but are higher at explantation (40.4 ± 19 ng/ml; p = 0.005 versus pre-LVAD). Galectin-3 levels >30 ng/ml are associated with lower survival post-LVAD placement (76.5 % versus 95.0 % at 2 years, p = 0.009). After HTx, galectin-3 levels are lower (17.8 ± 7.1 ng/ml post-HTx versus 28.2 ± 14 pre-HTx; p < 0.0001). Patients with coronary allograft vasculopathy (CAV) post-HTx showed higher galectin-3 levels (20.5 ± 8.8 ng/ml versus 16.8 ± 6.3, p = 0.1) and the degree of CAV correlated with levels of galectin-3 (r (2) = 0.17, p < 0.0001). CONCLUSIONS Galectin-3 is associated with the severity of HF, exhibits dynamic changes during mechanical unloading and predicts survival post-LVAD. Further, galectin-3 is associated with the development on CAV post-HTx. Galectin-3 might serve as a novel biomarker in patients with HF, during LVAD support and following HTx.
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Affiliation(s)
- Ellie Coromilas
- Department of Medicine, Division of Cardiology, Columbia University Medical Center, 166 Fort Washington Avenue, New York, NY, 10032, USA
| | - Em-Claire Que-Xu
- Department of Medicine, Division of Cardiology, Columbia University Medical Center, 166 Fort Washington Avenue, New York, NY, 10032, USA
| | - D'Vesharronne Moore
- Department of Medicine, Division of Cardiology, Columbia University Medical Center, 166 Fort Washington Avenue, New York, NY, 10032, USA
| | - Tomoko S Kato
- Department of Medicine, Division of Cardiology, Columbia University Medical Center, 166 Fort Washington Avenue, New York, NY, 10032, USA
| | - Christina Wu
- Department of Medicine, Division of Cardiology, Columbia University Medical Center, 166 Fort Washington Avenue, New York, NY, 10032, USA
| | - Ruiping Ji
- Department of Medicine, Division of Cardiology, Columbia University Medical Center, 166 Fort Washington Avenue, New York, NY, 10032, USA
| | - Raymond Givens
- Department of Medicine, Division of Cardiology, Columbia University Medical Center, 166 Fort Washington Avenue, New York, NY, 10032, USA
| | - Ulrich P Jorde
- Department of Medicine, Division of Cardiology, Columbia University Medical Center, 166 Fort Washington Avenue, New York, NY, 10032, USA
| | - Hiroo Takayama
- Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center, 166 Fort Washington Avenue, New York, NY, 10032, USA
| | - Yoshifumi Naka
- Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center, 166 Fort Washington Avenue, New York, NY, 10032, USA
| | - Isaac George
- Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center, 166 Fort Washington Avenue, New York, NY, 10032, USA
| | - Donna Mancini
- Department of Medicine, Division of Cardiology, Columbia University Medical Center, 166 Fort Washington Avenue, New York, NY, 10032, USA
| | - P Christian Schulze
- Department of Medicine, Division of Cardiology, Columbia University Medical Center, 166 Fort Washington Avenue, New York, NY, 10032, USA. .,Department of Medicine, Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, Friedrich-Schiller-University Jena, Erlanger Allee 101, 07743, Jena, Germany.
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