Changes in Outcomes of Cardiac Allograft Vasculopathy Over 30 Years Following Heart Transplantation.
JACC Heart Fail
; 5(12): 891-901, 2017 12.
Article
em En
| MEDLINE
| ID: mdl-29191295
ABSTRACT
OBJECTIVES:
This study investigated temporal changes in the demographics and the prognosis of cardiac allograft vasculopathy (CAV) over 30 years following heart transplantation (HTx).BACKGROUND:
Effects of the changing HTx demographics on CAV outcomes, based on International Society for Heart and Lung Transplantation (ISHLT) classification of CAV, have been incompletely investigated.METHODS:
Patients who underwent HTx at the Montreal Heart Institute were classified according to the severity of CAV (CAV 0 is no presence of CAV; CAV 1 is mild, CAV 2 to 3 is moderate to severe) and era of HTx (early 1983 to 1998; recent 1999 to 2011). We compared the risk of progression, survival, and independent predictors of outcomes among the groups.RESULTS:
A total of 298 patients were followed for 11.6 ± 6.6 years. Patients who received transplants in the early era exhibited a higher risk for progression from CAV 1 to a higher grade (adjusted odds ratio 8.0; 95% confidence interval [CI] 1.01 to 62.6). The presence of CAV was associated with a significantly increased risk for all-cause mortality in the early era (hazard ratio [HR] 1.6; 95% CI 1.1 to 2.5) but not in the recent era (HR 1.1; 95% CI 0.2 to 4.9). Regardless of the era, CAV classes 2 to 3 and CAV 1 were associated with a significantly increased risk for all-cause mortality compared to CAV 0 (HR 6.5; 95% CI 2.7 to 15.7; and HR 1.750; 95% CI 1.001 to 3.046, respectively).CONCLUSIONS:
The progression and prognosis of CAV have improved over 30 years. The ISHLT CAV classification accurately and independently predicts long-term outcome following HTx.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Transplante de Coração
/
Medição de Risco
/
Previsões
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Rejeição de Enxerto
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Insuficiência Cardíaca
Tipo de estudo:
Etiology_studies
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Observational_studies
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Prognostic_studies
/
Risk_factors_studies
Limite:
Adult
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Female
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Humans
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Male
/
Middle aged
Idioma:
En
Revista:
JACC Heart Fail
Ano de publicação:
2017
Tipo de documento:
Article
País de afiliação:
Canadá