Abstract 2576: Impact of Donor-transmitted Atherosclerosis on Early Cardiac Allograft Vasculopathy; New Findings by 3-D IVUS
OBJECTIVES: Despite increasing knowledge about poor clinical outcomes with the progression in intimal thickening detected by IVUS during the first year after cardiac transplantation (Tx), little is known about the influence of donor-transmitted coronary atherosclerosis. The aim of this study was to investigate the impact of donor-transmitted coronary atherosclerosis on cardiac allograft vasculopathy (CAV).
METHODS: Serial IVUS studies were performed within 8 weeks (baseline: BL) and at 1 year after Tx in 37 recipients. On the basis of maximum intimal thickness (MIT) at BL, recipients were divided into donor-transmitted atherosclerotic group (A+: MIT≥0.5mm, n=23) or non-atherosclerotic group (A-: MIT<0.5mm, n=14). Mean values of plaque, lumen and vessel area were calculated by volumetric analysis in the proximal left anterior descending artery over a 50mm length and coronary structural changes were assessed in each group.
RESULTS: During the first year after Tx, the mean plaque area increased significantly in group A+, but did not change in Group A- (Figure⇓). In both groups mean vessel area decreased significantly (A+, 16.25 ± 3.59 to 14.61 ± 3.26 mm3/mm, P<0.0027 : A-, 13.59 ± 4.18 to 11.90 ± 3.37 mm3/mm, P=0.0034), as did mean lumen area (A+, 13.21 ± 3.05 to 10.53 ± 2.70 mm3/mm, P<0.0001 : A-, 12.30 ± 3.85 to 10.63 ± 3.10 mm3/mm, P=0.003). In group A+, plaque progression contributed to 39% of the lumen loss, while no contribution was observed in group A-.
CONCLUSION: Donor-transmitted coronary atherosclerosis was associated with significant plaque progression during the first year after Tx, and in conjunction with negative remodeling, may be an important determinant of CAV.