Association of periarterial neovascularization with progression of cardiac allograft vasculopathy and long-term clinical outcomes in heart transplant recipients

JOURNAL OF HEART AND LUNG TRANSPLANTATION

卷:35

Article

Kitahara, Hideki¹  Okada, Kozo¹  Tanaka, Shigemitsu¹  Yang, Hyoung-Mo¹  Miki, Kojiro¹  Kobayashi, Yuhei¹  Kimura, Takumi¹  Luikart, Helen¹  Yock, Paul. G.¹  Yeung, Alan C.¹  Fitzgerald, Peter J.¹  Khush, Kiran K.¹  Fearon, William F.¹  Honda, Yasuhiro¹ 

[1] Stanford Univ, Sch Med, Div Cardiovasc Med, Stanford Cardiovasc Inst, Stanford, CA 94305 USA

关键词: cardiac allograft vasculopathy;    neovascularization;    intravascular ultrasound;    heart transplantation;    periarterial small vessels;   

DOI  :  10.1016/j.healun.2016.02.002

来源: Elsevier

【 摘 要 】

BACKGROUND: This study investigated the relationship between periarterial neovascularization, development of cardiac allograft vasculopathy (CAV), and long-term clinical outcomes after heart transplantation. Proliferation of the vasa vasorum is associated with arterial inflammation. The contribution of angiogenesis to the development of CAV has been suggested. METHODS: Serial (baseline and 1-year post-transplant) intravascular ultrasound was performed in 102 heart transplant recipients. Periarterial small vessels (PSV) were defined as echolucent luminal structures <1 mm in diameter, located <= 2 mm outside of the external elastic membrane. The signal void structures were excluded when they connected to the coronary lumen (considered as side branches) or could not be followed in >= 3 contiguous frames. The number of PSV was counted at 1-mm intervals throughout the first 50 mm of the left anterior descending artery, and the PSV score was calculated as the sum of cross-sectional values. Patients with a PSV score increase of >= 4 between baseline and 1 year post-transplant were classified as the proliferative group. Maximum intimal thickness was measured for the entire analysis segment. RESULTS: During the first year post-transplant, the proliferative group showed a greater increase in maximum intimal thickness (0.33 +/- 0.36 mm vs 0.10 +/- 0.28 mm, p < 0.001) and had a higher incidence of acute cellular rejection (50.0% vs 23.9%, p = 0.025) than the non-proliferative group. On Kaplan-Meier analysis, cardiac death-free survival rate over a median of 4.7 years was significantly lower in the proliferative group than in the non-proliferative group (hazard ratio, 3.10; p = 0.036). CONCLUSIONS: The increase in PSV, potentially representing an angioproliferative response around the coronary arteries, was associated with early CAV progression and reduced survival after heart transplantation. (C) 2016 International Society for Heart and Lung Transplantation. All rights reserved.

【 授权许可】

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