Inflammatory Burden of Cardiac Allograft Coronary Atherosclerotic Plaque Is Associated With Early Recurrent Cellular Rejection and Predicts a Higher Risk of Vasculopathy Progression

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:53

Article

Raichlin, Eugenia^1,2  Bae, Jang-Ho²  Kushwaha, Sudhir S.¹  Lennon, Ryan J.³  Prasad, Abhiram¹  Rihal, Charanjit S.¹  Lerman, Amir^1,2 

[1] Mayo Clin, Div Cardiovasc Dis, Rochester, MN 55905 USA

[2] Mayo Clin, Ctr Coronary Physiol & Imaging, Rochester, MN 55905 USA

[3] Mayo Clin, Div Biostat, Rochester, MN 55905 USA

关键词: cardiac transplantation;    rejection;    coronary allograft;    vasculopathy;    intravascular ultrasound;   

DOI  :  10.1016/j.jacc.2008.12.041

来源: Elsevier

【 摘 要 】

Objectives This study was designed to investigate tissue characterization of the coronary allograft atherosclerotic plaque with virtual histology intravascular ultrasound (VH-IVUS) imaging to assess the presence and predictors of vessel wall inflammation and its significance in cardiac allograft vasculopathy (CAV) progression. Background A unique form of accelerated atherosclerosis, CAV remains the leading cause of late morbidity and mortality in heart transplant patients. The pathogenesis of CAV is not fully elucidated. Methods A total of 86 patients with coronary allograft vasculopathy underwent VH-IVUS examination of the left anterior descending coronary artery 3.61 +/- 3.04 years following cardiac transplantation. Based on the VH-IVUS plaque characteristics, coronary allograft plaque was divided on virtual histology intravascular ultrasound-derived inflammatory (VHD-IP) (necrotic core and dense calcium <30%) and noninflammatory plaque (VHD-NIP) (necrotic core and dense calcium <30%). Total rejection scores were calculated based on the 2004 International Society of Heart and Lung Transplantation rejection grading system. Results In the whole study population, the mean percentage of fibrous, fibrofatty, dense calcified, and necrotic core plaques in a mean length of 62.3 +/- 17.4 mm of the left anterior descending coronary artery were 50 +/- 17%, 16 +/- 11%, 15 +/- 11%, and 18 +/- 9%, respectively. Patients with a 6-month total rejection score <= 0.3 had significantly higher incidence of VHD-IP than those with a 6-month total rejection score <= 0.3 (69% vs. 33%, p = 0.011). The presence of VHD-IP at baseline was associated with a significant increase in plaque volume (2.42 +/- 1.78 mm(3)/mm vs. -0.11 +/- 1.65 mm(3)/mm, p = 0.010), plaque index (7 +/- 9% vs. 0 +/- 8%, p = 0.04), and remodeling index (1.24 +/- 0.44 vs. 1.09 +/- 0.36, p = 0.030) during 12 months of follow-up when compared with the presence of VHD-NIP at baseline and during follow-up. Conclusions The presence of VHD-IP as assessed by VH-IVUS is associated with early recurrent rejection and with higher subsequent progression of CAV. A VH-IVUS assessment may add important information in the evaluation of transplant recipients. (J Am Coll Cardiol 2009; 53: 1279-86) (c) 2009 by the American College of Cardiology Foundation

【 授权许可】

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