Index of microvascular resistance after early conversion from calcineurin inhibitor to everolimus in heart transplantation: A sub-study to a 1-year randomized trial

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• 作者：Ole Geir Solberg ; MD^a ; ^b ; ^{o.g.solberg@medisin.uio.no" class="auth_mail" title="E-mail the corresponding author} ; Knut Stavem ; MD ; MPH ; PhD^b ; ^c ; ^d ; Asgrimur Ragnarsson ; MD^a ; Dan Ioanes ; MD^e ; Satish Arora ; MD ; PhD^a ; Knut Endresen ; MD ; PhD^a ; Jūratė &Scaron ; altytė Benth ; PhD^b ; ^d ; Lars Gullestad ; MD ; PhD^a ; ^f ; Einar Gude ; MD ; PhD^a ; Arne K. Andreassen ; MD ; PhD^a ; Lars Aaberge ; MD ; PhD^a
• 关键词：coronary physiology ; coronary microcirculation ; index of microvascular resistance (IMR) ; heart transplantation ; everolimus ; mTOR inhibitors
• 刊名：Journal of Heart and Lung Transplantation
• 出版年：2016
• 出版时间：August 2016
• 年：2016
• 卷：35
• 期：8
• 页码：1010-1017
• 全文大小：253 K

文摘

Microvascular function in transplanted hearts can be evaluated by methods used in routine left heart catheterization follow-up after heart transplantation (HTx). This sub-study of a randomized study compared the effects of everolimus (EVR) and calcineurin inhibitor (CNI) treatment on microvascular function as expressed by the index of microvascular resistance (IMR) at 1 year after HTx. A secondary objective was to compare the change in IMR from 7–11 weeks to 1 year after HTx between randomized groups.

Methods

There were 70 HTx recipients included and randomly assigned to combination therapy (EVR and CNI with early CNI withdrawal) vs conventional CNI treatment. Coronary physiologic assessment was performed 7–11 weeks and 1 year after HTx. A linear mixed model was used to assess the group difference at 1 year and the difference in IMR change between 7–11 weeks and 1 year after HTx.

Results

At 1 year, there was no significant difference in IMR between the EVR group (17.5 mm Hg∙sec ± 8.9) (mean ± SD) and the CNI group (14.9 mm Hg∙sec ± 6.6, p = 0.17). The difference in IMR change between the 2 treatment arms was 1.6 mm Hg∙sec (95% confidence interval, −2.8 to 5.9; p = 0.49). Spearman’s rank correlation coefficient at 1 year after HTx between IMR and maximal intimal thickness as assessed with intravascular ultrasound in the left anterior descending artery was −0.13 (p = 0.28).

Conclusions

In this prospective, open, randomized study comparing early CNI withdrawal with mammalian target of rapamycin inhibitors immunosuppression during the first year after HTx, early transition from CNI-based immunosuppression to EVR-based treatment did not result in differences in microvascular function as assessed by the IMR.