Circulation, Vol 88, 1093-1100, Copyright © 1993 by American Heart Association
TJ Anderson, IT Meredith, A Uehata, GH Mudge, AP Selwyn, P Ganz and AC Yeung
BACKGROUND. Detection of transplant coronary disease remains difficult.
Both intravascular ultrasound (IVUS) imaging and functional coronary
vasomotion studies have been used to evaluate this process. However, the
time course of intimal thickening as assessed by IVUS and the relation
between structure and function have not been explored. METHODS AND RESULTS.
In 40 patients 1 to 8 years after transplantation, 108 coronary artery
segments were analyzed by IVUS. Intimal index [% intimal area
(lumen+intimal area)] and maximal thickness were used to quantify intimal
thickening. Abnormal IVUS was present in 53 of 108 segments (49%) (mean
intimal index of diseased segments, 23 +/- 2%; maximal thickness, 530 +/-
47 microns). For those patients with intimal thickening in all segments of
the analyzed artery, more time had elapsed since transplantation (4.3 +/-
0.6 years) than for those whose arteries contained some normal (2.6 +/- 0.3
years) or all normal segments (2.2 +/- 0.6 years, P < .05). Both the
proportion of segments with intimal thickening and the degree of thickening
increased as a function of time after transplantation (P < .5). By
multivariate analysis, the independent predictors of intimal thickening
were increasing time after transplantation and pretransplantation
hypercholesterolemia (P = .02). Within the cohort of 40 patients,
endothelium-dependent vasomotor function was evaluated in 26 matched
segments from 11 patients studied 1 year after transplantation and in 15
matched segments from 8 patients studied > or = 5 years after
transplantation by serial infusions of acetylcholine (10(-8) to 10(-6)
mol/L). Of the 26 segments assessed for structure/function correlation at 1
year after transplantation, 22 had no intimal thickening by IVUS. However,
endothelial dysfunction was present in 13 of these normal segments (mean
diameter constriction, 18.8 +/- 2.3%). Of the 15 segments studied > or =
5 years after transplantation, 11 had intimal thickening. Nine of these 11
segments had preserved endothelial function (mean diameter dilation, 8.6
+/- 2.9%). There was no relation between the degree of intimal thickening
and the magnitude of the endothelium-dependent response to acetylcholine.
CONCLUSIONS. This study has shown that intimal thickening after
transplantation begins as a heterogeneous process and increases in extent
and magnitude over time. Also, endothelial dysfunction occurs early before
the intimal thickening; yet in those patients surviving > or = 5 years,
endothelial function may recover even in the presence of moderate intimal
pathology. The variable relation between intimal pathology and endothelial
function is probably a result of the episodic nature of immune injury.
ARTICLES
Functional significance of intimal thickening as detected by intravascular ultrasound early and late after cardiac transplantation
Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115.
This article has been cited by other articles:
 |
|
 |
|
  G. Vassalli, A. Gallino, M. Weis, W. von Scheidt, L. Kappenberger, L.K. von Segesser, J.-J. Goy, and on behalf of the Working Group Microcirculation of Alloimmunity and nonimmunologic risk factors in cardiac allograft vasculopathy Eur. Heart J., July 1, 2003; 24(13): 1180 - 1188. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. T. Bethea, D. D. Yuh, J. V. Conte, and W. A. Baumgartner Heart Transplantation Card. Surg. Adult, January 1, 2003; 2(2003): 1427 - 1460. [Full Text]
|
|
|
|
 |
|
 V. Marti, I. Romeo, R. Aymat, J. Garcia, P. Guiteras, M. Ballester, N. Aminian, J. M. Caralps, and J. M. Auge Coronary endothelial dysfunction as a predictor of intimal thickening in the long term after heart transplantation J. Thorac. Cardiovasc. Surg., December 1, 2001; 122(6): 1174 - 1180. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. A. Beckman, J. Ganz, M. A. Creager, P. Ganz, and S. Kinlay Relationship of Clinical Presentation and Calcification of Culprit Coronary Artery Stenoses Arterioscler. Thromb. Vasc. Biol., October 1, 2001; 21(10): 1618 - 1622. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K Pethig, V Klauss, B Heublein, H Mudra, A Westphal, C Weber, K Theisen, and A Haverich Progression of cardiac allograft vascular disease as assessed by serial intravascular ultrasound: correlation to immunological and non-immunological risk factors Heart, November 1, 2000; 84(5): 494 - 498. [Abstract] [Full Text]
|
|
|
|
 |
|
 R. Din-Dzietham, D. Liao, A. Diez-Roux, F. J. Nieto, C. Paton, G. Howard, A. Brown, M. Carnethon, and H. A. Tyroler Association of Educational Achievement with Pulsatile Arterial Diameter Change of the Common Crotid Artery The Atherosclerosis Risk in Communities (ARIC) Study, 1987-1992 Am. J. Epidemiol., October 1, 2000; 152(7): 617 - 627. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. E NEWBY Intracoronary infusions and the assessment of coronary blood flow in clinical studies Heart, August 1, 2000; 84(2): 118 - 120. [Full Text] [PDF]
|
|
|
|
 |
|
 M. A. Kuhn, K. R. Jutzy, D. D. Deming, C. E. Cephus, R. E. Chinnock, J. Johnston, L. L. Bailey, and R. L. Larsen The medium-term findings in coronary arteries by intravascular ultrasound in infants and children after heart transplantation J. Am. Coll. Cardiol., July 1, 2000; 36(1): 250 - 254. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. P. Schwarzacher, N. G. Uren, M. R. Ward, A. Schwarzkopf, N. Giannetti, S. Hunt, P. J. Fitzgerald, S. N. Oesterle, and A. C. Yeung Determinants of Coronary Remodeling in Transplant Coronary Disease : A Simultaneous Intravascular Ultrasound and Doppler Flow Study Circulation, March 28, 2000; 101(12): 1384 - 1389. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. J. Anderson Assessment and treatment of endothelial dysfunction in humans J. Am. Coll. Cardiol., September 1, 1999; 34(3): 631 - 638. [Full Text] [PDF]
|
|
|
|
|
|
C. H. Spes, V. Klauss, H. Mudra, S. D. Schnaack, A. R. Tammen, J. Rieber, U. Siebert, K.-H. Henneke, P. Uberfuhr, B. Reichart, et al. Diagnostic and Prognostic Value of Serial Dobutamine Stress Echocardiography for Noninvasive Assessment of Cardiac Allograft Vasculopathy : A Comparison With Coronary Angiography and Intravascular Ultrasound Circulation, August 3, 1999; 100(5): 509 - 515. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. V. McConnell, M. Aikawa, S. E. Maier, P. Ganz, P. Libby, and R. T. Lee MRI of Rabbit Atherosclerosis in Response to Dietary Cholesterol Lowering Arterioscler. Thromb. Vasc. Biol., August 1, 1999; 19(8): 1956 - 1959. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. P Perrault, J.-P. Bidouard, P. Janiak, N. Villeneuve, P. Bruneval, J.-P. Vilaine, and P. M Vanhoutte Impairment of G-protein-mediated signal transduction in the porcine coronary endothelium during rejection after heart transplantation Cardiovasc Res, August 1, 1999; 43(2): 457 - 470. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Pethig, B. Heublein, R. R. Meliss, and A. Haverich Volumetric remodeling of the proximal left coronary artery: Early versus late after heart transplantation J. Am. Coll. Cardiol., July 1, 1999; 34(1): 197 - 203. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P.F. Ludman, F. Lazem, M. Barbir, and M. Yacoub Incidence and clinical relevance of coronary calcification detected by electron beam computed tomography in heart transplant recipients Eur. Heart J., February 2, 1999; 20(4): 303 - 308. [Abstract] [PDF]
|
|
|
|
 |
|
 M. F. Di Carli, M. C. Tobes, T. Mangner, A. B. Levine, O. Muzik, P. Chakroborty, and T. B. Levine Effects of Cardiac Sympathetic Innervation on Coronary Blood Flow N. Engl. J. Med., April 24, 1997; 336(17): 1208 - 1216. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. T. Lim, D. H. Liang, J. Botas, J. S. Schroeder, S. N. Oesterle, and A. C. Yeung Role of Compensatory Enlargement and Shrinkage in Transplant Coronary Artery Disease: Serial Intravascular Ultrasound Study Circulation, February 18, 1997; 95(4): 855 - 859. [Abstract] [Full Text]
|
|
|
|
|
|
K. F. Kofoed, J. Czernin, J. Johnson, J. Kobashigawa, M. E. Phelps, H. Laks, and H. R. Schelbert Effects of Cardiac Allograft Vasculopathy on Myocardial Blood Flow, Vasodilatory Capacity, and Coronary Vasomotion Circulation, February 4, 1997; 95(3): 600 - 606. [Abstract] [Full Text]
|
|
|
|
|
|
G. Vassalli, A. Gallino, W. Kiowski, Z. Jiang, M. Turina, and O. M. Hess Reduced Coronary Flow Reserve During Exercise in Cardiac Transplant Recipients Circulation, February 4, 1997; 95(3): 607 - 613. [Abstract] [Full Text]
|
|
|
|
|
|
S. F. Davis, A. C. Yeung, I. T. Meredith, F. Charbonneau, P. Ganz, A. P. Selwyn, and T. J. Anderson Early Endothelial Dysfunction Predicts the Development of Transplant Coronary Artery Disease at 1 Year Posttransplant Circulation, February 1, 1996; 93(3): 457 - 462. [Abstract] [Full Text]
|
|
|
|
|
|
E. A. Caracciolo, T. L. Wolford, R. D. Underwood, T. J. Donohue, R. G. Bach, L. W. Miller, and M. J. Kern Influence of Intimal Thickening on Coronary Blood Flow Responses in Orthotopic Heart Transplant Recipients : A Combined Intravascular Doppler and Ultrasound Imaging Study Circulation, November 1, 1995; 92(9): 182 - 190. [Abstract] [Full Text]
|
|
|
|
|
|
D. Hausmann, R. Erbel, M.-J. Alibelli-Chemarin, W. Boksch, E. Caracciolo, J. M. Cohn, S. C. Culp, W. G. Daniel, I. De Scheerder, C. DiMario, et al. The Safety of Intracoronary Ultrasound : A Multicenter Survey of 2207 Examinations Circulation, February 1, 1995; 91(3): 623 - 630. [Abstract] [Full Text]
|
|