Impact of coronary endothelial dysfunction on adverse long-term outcome after heart transplantation

Transplantation. 2008 Jun 15;85(11):1580-7. doi: 10.1097/TP.0b013e318170b4cd.


Background: Coronary vasomotor dysfunction is a common finding in cardiac transplant recipients and is an early marker for the development of graft atherosclerosis. The present prospective study tested whether endothelial dysfunction independently predicts cardiovascular-related events and death after heart transplantation (HTx).

Methods: Functional and structural coronary changes were evaluated in 185 consecutive patients 25+/-33 months after HTx. The following potential risk factors for graft survival were assessed at baseline: hypertension, diabetes, dyslipidemia, donor and recipient characteristics (age, gender, cytomegalovirus-infection, human leukocyte antigen-mismatch), pretransplantation diagnosis, ischemic time, treated rejection episodes, immunosuppressive regimens, and medication.The prespecified prospectively defined endpoints were cardiovascular-related events with progressive heart failure, acute myocardial infarction, coronary revascularization, retransplantation, and death. Patients were followed-up for 60+/-17 months.

Results: Event-free survival for the entire group was 73% (25 cardiovascular-related events, 25 deaths). Using multivariate analysis, epicardial endothelial dysfunction (relative risk [RR] 1.97; P=0.028), angiographic cardiac allograft vasculopathy (RR 2.11; P=0.023), diabetes (RR 2.32; P=0.022), high serum levels of CyA (RR 3.54; P=0.006) and Tac (RR 6.82; P=0.002), uncommon reasons for transplantation (RR 4.69; P=0.002), and the absence of statin therapy (RR 0.33; P=0.025) were detected as independent predictors of cardiovascular-related events and death.

Conclusion: This is the first study showing that epicardial endothelial dysfunction independently predicts outcome in HTx patients providing functional and prognostic information that complete angiographic risk factor assessment.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Blood Flow Velocity / physiology
  • Cause of Death / trends
  • Coronary Angiography
  • Coronary Circulation / physiology
  • Coronary Disease / diagnosis
  • Coronary Disease / mortality
  • Coronary Disease / physiopathology*
  • Coronary Vessels / diagnostic imaging
  • Coronary Vessels / physiopathology*
  • Endothelium, Vascular / diagnostic imaging
  • Endothelium, Vascular / physiopathology*
  • Female
  • Follow-Up Studies
  • Graft Rejection / diagnosis
  • Graft Rejection / physiopathology
  • Graft Rejection / prevention & control*
  • Heart Transplantation / physiology*
  • Humans
  • Male
  • Microcirculation / physiology
  • Middle Aged
  • Prognosis
  • Proportional Hazards Models
  • Prospective Studies
  • Risk Factors
  • Time Factors
  • Ultrasonography, Doppler / methods
  • Ultrasonography, Interventional / methods
  • Vascular Resistance / physiology*