Induction treatment with monoclonal antibodies for heart transplantation.

Individualization of induction therapy for heart transplantation (HT) is needed, given that only patients at significant risk for fatal rejection seem to present a favorable risk-benefit ratio. The question whether monoclonal interleukin 2 antagonists or antilymphocyte antibodies should be recommended remains unanswered. As most studies suggest that they have similar efficacy in preventing acute rejection, other variables related to safety or management costs should be taken into account. The cytokine release syndrome, associated with the use of OKT3, complicates management of HT patient. The experience in our center with 2 consecutive cohorts, treated with basiliximab (BAS) and OKT3, respectively, suggests that the use of BAS is associated, in addition to similar immunosuppressive efficacy and better safety profile than OKT3, with simpler patient management during the initial hospital stay, which could be associated with a reduction in posttransplant costs. Because few centers continue to use OKT3 as induction therapy in HT, more studies comparing cost-effectiveness of BAS vs polyclonal antilymphocyte antibodies (ATG) are needed.

Dual quantitative coronary angiography: a novel approach to quantify intracoronary thrombotic burden.

AIMS: To validate and test in vivo a new modality of quantitative coronary angiography (QCA), dual QCA (D-QCA), developed to quantify intracoronary thrombotic burden (ITB). METHODS AND RESULTS: Calculation of ITB with D-QCA is based on the discrepancy of luminal areas assessed with edge detection (ED) and video-densitometry (VD), measured with Cardiovascular Angiography Analysis System II. Experimental validation was first performed in phantoms with known obstructive volumes. In vivo assessment of thrombotic burden changes was performed in angiograms from 19 patients with large ITB, obtained before and after antithrombotic treatment, and compared with semi-quantitative assessment (TIMI thrombus grade (TTG)). A good correlation between D-QCA and true occlusive volumes was found (y = 9.21+0.99x, r = 0.996). Intra- and inter-observer variability was 2.77 +/- 10.97 mm3 (p = 0.50) and -1.28 +/- 6.99 mm3 (p = 0.62) respectively. In vivo, D-QCA demonstrated a significant reduction in ITB resulting from treatment (137.22 +/- 120.13 mm3 before and 104.72 +/- 99.19 mm3 after treatment, p = 0.001). Overall, TTG also decreased (3.63 +/- 0.68 before and 3.11 +/- 1.20 after, p = 0.008), but in those nine (47%) patients in which remained unchanged D-QCA detected a reduction in ITB (pre 148.17 +/- 154.03 mm3, post 112.86 +/- 117.82 mm3, p = 0.05). CONCLUSIONS: D-QCA appears as a useful approach to quantify IC thrombus volume, being more sensitive than TTG in assessing changes in ITB resulting from treatment strategies.