Abstract 2575: Negative Remodeling is Primarily Responsible for Coronary Artery Lumen Loss Early After Cardiac Transplantation: Role of Cytomegalovirus
Background: Coronary artery dimensions change significantly early after cardiac transplantation due to intimal thickening and vessel remodeling. However, the degree to which these changes impact coronary lumen dimensions, and the contributing clinical factors remain controversial.
Methods: Coronary angiography and 3-D IVUS analysis of the left anterior descending artery were performed in 38 cardiac transplant recipients within 8 weeks of transplantation and at 1 year follow up. Clinical parameters including donor and recipient characteristics, rejection episodes, and serology were recorded prospectively. Multivariate analysis was done to determine which, if any, clinical parameters predicted changes in coronary dimensions.
Results: At 1 year follow up, mean lumen area (12.9±3.0 to 10.5±2.5 mm2, p<0.01) and mean vessel area (15.4±3.7 to 13.7±3.2 mm2, p<0.01) decreased significantly, while mean intimal area (2.5±1.6 to 3.2±1.8 mm2, p<0.01) increased significantly, despite no angiographic evidence of coronary disease. Lumen loss strongly correlated with the degree of negative remodeling (r=0.90, p<0.01), but not with intimal thickening (r=0.03, p=0.88). Transplant recipient cytomegalovirus (CMV) antibody seropositivity and lack of aggressive prophylaxis against CMV infection/reactivation were the strongest independent predictors of greater negative remodeling and greater lumen loss, respectively (p<0.05 for all).
Conclusion: Despite significant intimal thickening, negative remodeling is primarily responsible for coronary artery lumen loss during the first year after cardiac transplantation. CMV infection appears to contribute to these changes.