Document 0543
 DOCN  M9620543
 TI    Predictive model to assess risk for cardiac allograft vasculopathy: an
       intravascular ultrasound study.
 DT    9602
 AU    Mehra MR; Ventura HO; Chambers R; Collins TJ; Ramee SR; Kates MA; Smart
       FW; Stapleton DD; Department of Internal Medicine, Ochsner Medical
       Institutions,; New Orleans, Louisiana 70121, USA.
 SO    J Am Coll Cardiol. 1995 Nov 15;26(6):1537-44. Unique Identifier :
       AIDSLINE MED/96060951
 AB    OBJECTIVES: This study was performed to assess the influence and
       interdependence of immunologic and nonimmunologic risk factors in the
       development of cardiac allograft vasculopathy. Another primary objective
       was to establish a clinically useful model for risk assessment of
       cardiac allograft vasculopathy that would facilitate identifying those
       heart transplant recipients likely to have severe intimal proliferation
       and thereby at greater risk for adverse clinical events. BACKGROUND: To
       our knowledge, no comprehensive intravascular ultrasound study has
       assessed the relative influences of both nonimmunologic and immunologic
       factors in the development of cardiac allograft vasculopathy, currently
       the major limitation to long-term cardiac allograft survival. METHODS:
       Using a computer-assisted model of stepwise logistic regression,
       immunologic and nonimmunologic risk factors were evaluated to help
       identify the development of severe intimal thickening in 101 subjects
       who underwent intravascular ultrasound. Prospective validation of the
       findings was performed in a separate consecutive cohort of 37 heart
       transplant recipients, and the accuracy of this model to predict a
       relative risk > 1 for the development of severe intimal hyperplasia was
       assessed. RESULTS: Significant independent predictors of severe intimal
       hyperplasia in this model included a donor age > 35 years, a first-year
       mean biopsy score > 1 (a measure not only of severity of rejection, but
       also of frequency of insidious rejection) and hypertriglyceridemia at
       two incremental levels of risk (150 to 250 mg/dl [1.70 to 2.83
       mmol/liter] and > 250 mg/dl [2.83 mmol/liter]). Based on the absence (0)
       or presence (1) of these factors, 12 individual categories of risk were
       ascertained with increasing relative risks and predicted probabilities
       for severe intimal hyperplasia. Prospective validation of this model
       revealed a sensitivity and specificity of 70% and 90%, respectively, and
       the positive and negative predictive values were 85% and 80%,
       respectively. Additionally, subjects with severe intimal thickening had
       a four-fold higher cardiac event rate than those without severe intimal
       proliferation on intravascular ultrasound. CONCLUSIONS: This study
       establishes a clinically useful predictive model that can be applied to
       individual heart transplant recipients to assess their risk for
       developing significant cardiac allograft vasculopathy and, thus, aids in
       the identification of patients at risk for cardiac events in whom closer
       surveillance and risk factor modification may be warranted.
 DE    Adult  Aged  Confounding Factors (Epidemiology)  Coronary
       Vessels/*PATHOLOGY/*ULTRASONOGRAPHY  Death, Sudden, Cardiac/ETIOLOGY
       Female  Graft Rejection/IMMUNOLOGY  Heart Transplantation/*ADVERSE
       EFFECTS/IMMUNOLOGY/PATHOLOGY/  *ULTRASONOGRAPHY  Human
       Immunosuppression  Logistic Models  Male  Middle Age  Myocardial
       Infarction/ETIOLOGY  Predictive Value of Tests  Prospective Studies
       Risk Factors  Sensitivity and Specificity  Transplantation, Homologous
       Tunica Intima/PATHOLOGY/ULTRASONOGRAPHY  JOURNAL ARTICLE

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).