Key result
Elevated CRP (>1.5 mg/L) was independently associated with advanced cardiac allograft vasculopathy (MIT >0.5 mm) in heart transplant recipients (OR 4.6, p<0.01).
Why the study?
Are systemic markers of inflammation associated with cardiac allograft vasculopathy and increased intimal inflammatory component in heart transplant recipients?
Observational (n=101)
Are systemic markers of inflammation associated with cardiac allograft vasculopathy and increased intimal inflammatory component in heart transplant recipients?
Odds Ratio: 4.6
p-value: p=< 0.01
Elevated systemic inflammatory markers, particularly CRP, VCAM-1, and neopterin, are independently associated with advanced cardiac allograft vasculopathy and vulnerable lesions in heart transplant recipients.
Elevated CRP may aid CAV risk stratification in heart transplant recipients; hypothesis-generating and warrants prospective validation before practice change.
We evaluated an extensive profile of clinical variables and immune markers to assess the inflammatory milieu associated with cardiac allograft vasculopathy (CAV) assessed by intravascular ultrasound (IVUS) and virtual histology (VH). In total, 101 heart transplant (HTx) recipients were included and underwent IVUS/VH examination and measurement of plasma C-reactive protein (CRP), soluble tumor necrosis factor receptor-1, interleukin-6, osteoprotegerin, soluble gp130, von Willebrand factor, vascular cell adhesion molecule-1 (VCAM-1) and neopterin. Mean Maximal Intimal Thickness (MIT) was 0.61 +/- 0.19 mm and mean fibrotic, fibrofatty, dense calcified and necrotic core components were 55 +/- 15, 14 +/- 10, 15 +/- 13 and 17 +/- 9%, respectively. In multivariate analysis, CRP > 1.5 mg/L (OR 4.6, p < 0.01), VCAM-1 > 391 ng/mL (adjusted OR 3.2, p = 0.04) and neopterin > 7.7 nmol/L (OR 3.8, p = 0.02) were independently associated with MIT > 0.5 mm. Similarly, CRP > 1.5 mg/L (OR 3.7, p < 0.01) and VCAM-1 > 391 (OR 2.7, p = 0.04) were independently associated with an increased intimal inflammatory component (dense calcified/necrotic core component > 30%). Advanced CAV is associated with elevated CRP, VCAM-1 and neopterin and the two former biomarkers are also associated with an increased intimal inflammatory component. Forthcoming studies should clarify if routine measurements of these markers can accurately identify HTx recipients at risk of developing advanced CAV and vulnerable lesions.
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Arora et al. (2010) conducted an observational in Cardiac allograft vasculopathy (n=101). Elevated systemic markers of inflammation (CRP, VCAM-1, neopterin) vs. Lower levels of inflammatory markers was evaluated on Maximal Intimal Thickness (MIT) > 0.5 mm (OR 4.6, p=< 0.01). Elevated CRP (>1.5 mg/L) was independently associated with advanced cardiac allograft vasculopathy (MIT >0.5 mm) in heart transplant recipients (OR 4.6, p<0.01).
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