Abstract 13653: Everolimus Prevents Endomyocardial Remodelling After Heart Transplantation
Background: Endomyocardial remodelling after heart transplantation is characterized by a patho-anatomical shift from a regular myocardial syncytium to progressive fibrosis and scars. The potential of everolimus to prevent this process has not been evaluated as yet.
Methods: We studied prospectively 132 patients who underwent biopsy follow-up at 4 weeks, 1 year and 3 years after heart transplantation. Fibrosis and scars (Zeiss Vision, in Sirius), collagens III and IV (immunohistochemistry) and cellular rejection (H&E) were studied in biopsy. Transplant vasculopathy was assessed by coronary angiography at each follow-up.
Results: Fibrosis increased slightly from 7.7±0.4% to 8.0±0.7%, while the amount of scar tissue ranged between 24.4±1.2% and 30±1.4%. Patients on everolimus presented with less fibrosis (6.6±0.5% vs. 8.7±0.6%, p=0.012; 6.8±0.6% vs. 8.4±0.7%, p=0.013; 6.6±0.6% vs.10.9±1.9%, p=0.007) and less scarring at 3 years post-transplant (19.9±1.9% vs. 31.9±4.6%, p=0.006). Patients with angiographic peripheral obliterations showed in the 1- and 3-year follow-up higher amounts of fibrosis (9.9±0.9% vs. 7.9±0.6%, p=0.030; 7.1±0.6% vs. 10.0±1.6%, p=0.041). In regression analysis, everolimus and beta blockers were identified as anti-fibrotic factors, while peripheral obliterations were pro-fibrotic. Acute cellular rejection episodes were not correlated to biopsy findings or immunosuppression.
Conclusions: Everolimus prevents endomyocardial remodelling after heart transplantation and has beneficial effects on preservation of the myocardial syncytium. Angiographic peripheral obliterations are linked to increased amounts of endomyocardial fibrosis, suggesting a relevant effect on microvascular perfusion.
- © 2010 by American Heart Association, Inc.