Progress of Angiographic Cardiac Allograft Vasculopathy in Patients With Long-Term Transplantation: Longitudinal Evaluation of Its Association With Dyslipidemia Patterns

Abstract

Cardiac allograft vasculopathy (CAV) is a progressive disease with limited options for secondary prevention. Ways to manage lipid parameters and dyslipidemia patterns in care after transplantation remain unclear. In this longitudinal study, we included 32 patients with long-term heart transplantations (median interval after transplant 13.8 years) with angiographic manifest CAV. In 299 matched nonstented segments at 3 distinct time points ([TPs] 0 to 2, with median intervals of 2 years, respectively), progress of diameter stenosis (Δ%DS) defined CAV progress. Values above the median of maximal Δ%DS defined substantial CAV progress. Category of left ventricular ejection fraction was evaluated at TP0 and TP3 (2 years after TP2). Findings were correlated with dyslipidemia patterns at TP0, and lipid variations at follow-up (TP1 to TP3). Analyses included routine lipid assessment, and triglycerides/high-density lipoprotein-cholesterol ratio (TG/HDL-c) and atherogenic index of plasma (AIP). At TP1 and TP2, patients with increase of TG/HDL-c ≥0.1 (p = 0.02, respectively) and with increase of AIP (p = 0.01 and p = 0.049, respectively) presented a greater maximal Δ%DS. Dyslipidemia patterns at TP0 did not show a relevant association with CAV progress. At TP2, increase of TGs, TG/HDL-c, and AIP were associated with substantial CAV progress (odds ratio [OR] 5.0, p = 0.046, and OR 9.2, p = 0.01, OR 6.6, p = 0.02, respectively). At TP3, patients with CAV-related worsening of left ventricular ejection fraction category presented with a greater increase of TG/HDL-c (p = 0.03). Although findings at TP0 did not affect CAV progress, an increase of TG/HDL-c could define patients at greater risk of CAV progress and CAV-related deterioration of graft function.