Cardiology · Surgery · 4 h ago
Everolimus Conversion Shows No Left Ventricular Mass Benefit After Heart Transplantation
An analysis of two randomized trials assessed left ventricular mass in 83 early and 75 maintenance heart transplant recipients. Replacing calcineurin inhibitors with everolimus early after transplantation, or combining everolimus with reduced-dose calcineurin inhibitors later, did not improve left ventricular mass changes relative to comparator treatment.
- Two randomized trials contributed 158 heart transplant recipients.
- Early left ventricular mass reductions were similar between treatment arms.
- Maintenance recipients showed no significant treatment-related difference over five years.
Calcineurin inhibitors have been implicated in left ventricular hypertrophy after heart transplantation. Investigators assessed echocardiographic left ventricular mass in 83 recipients from SCHEDULE and 75 maintenance recipients from NOCTET, two randomized controlled trials. SCHEDULE compared calcineurin inhibitor treatment with replacement by everolimus within 7–11 weeks after transplantation, with three years of follow-up. NOCTET compared calcineurin inhibitor treatment with everolimus plus low-dose calcineurin inhibitors over five years.
In SCHEDULE, left ventricular mass decreased over time, particularly during the first year: the reported change was −10 ± 18 g/m² in the everolimus arm and −9 ± 13 g/m² in the cyclosporine arm. The between-group difference in change was not significant (p = 0.91). In NOCTET, there was no significant change over time and no significant between-group difference in change (p = 0.27).
These findings do not support switching to everolimus or reducing calcineurin inhibitor exposure specifically to mitigate left ventricular hypertrophy after heart transplantation. The analysis concerns an echocardiographic surrogate rather than clinical cardiovascular outcomes. Only the abstract was available; it does not provide confidence intervals for treatment differences or details on missing echocardiographic data.
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Clinical Transplantation: Development in Left Ventricular Mass After Early and Late Conversion From Calcineurin Inhibitors to Everolimus in Heart Transplant Recipients—Results From Two Randomized Controlled Trials ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.