Angiographic, intravascular ultrasound and functional findings early after orthotopic heart transplantation.
Accelerated graft atherosclerosis is responsible for increased mortality and morbidity among heart transplant recipients. The aim of this in-vivo study was to evaluate coronary atherosclerotic vessel alterations and endothelial function. Seventeen patients (14 males; mean age 49.3 years; range 24 to 69) were studied an average of 11 weeks (range 5 to 21) after heart transplantation because of coronary artery disease (n = 8), dilative cardiomyopathy (n = 7), mitral valve replacement (n = 1) and left atrial metastases of a leiomyosarcoma (n = 1). Mean age of the donor hearts (9 males) was 29 years (range 12 to 55). All recipients underwent biplane ventriculography and coronary angiography. In this study population, a total of 120 coronary segments (main stem, 21; left anterior descending artery, 85; circumflex artery, 14) were analyzed by intravascular ultrasound (20 MHz, 3.5F). In 13 patients, acetylcholine was infused into the proximal left anterior descending artery (10(-8) to 10(-5) M) to evaluate vasomotion within this segment. Regional contraction abnormalities were documented in 2 patients. Nine segments angiographically showed non-critical stenoses (5 patients). Intravascular ultrasound detected 52 cross-sectional areas with a three-layer pattern indicating intimal thickening. Mean circumferential extension of intimal proliferation was 192 degrees, mean intimal thickness 0.35 mm. Only 5 segments of the sonographically pathological cross-sectional areas showed angiographical evidence of atherosclerotic lesions. Intracoronary administration of acetylcholine at doses of 10(-8) and 10(-7) M resulted in vasoconstriction of the examined coronary segment in only 2 patients; the intracoronary application of acetylcholine at doses of 10(-6) and 10(-5) M revealed coronary vasoconstriction in 10 of the total of 13 patients. Using intravascular ultrasound, coronary artery lesions in heart transplant recipients can already be depicted at a very early stage. The abnormal response to acetylcholine in most of the heart recipients is independent of the extent of atherosclerotic vessel abnormalities documented by ultrasound or angiography.
Kerber
S
S
Department of Cardiology and Angiology, Hospital of the Westfälische Wilhelms-University of Münster, Germany.
Rahmel
A
A
Heinemann-Vechtel
O
O
Budde
T
T
Deng
M
M
Scheld
H H
HH
Breithardt
G
G
D000109:Acetylcholine; D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000473:pathology* / Q000503:physiopathology; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000187:drug effects; D004730:Endothelium, Vascular / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D005260:Female; D016027:Heart Transplantation / Q000000981:diagnostic imaging / Q000473:pathology* / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D018084:Ultrasonography, Interventional; D014661:Vasoconstriction; D016277:Ventricular Function, Left; D017725:Ventricular Pressure / Q000187:drug effects
D000109:Acetylcholine