Regression of transplant coronary artery disease during chronic HELP therapy: a case study.
This report concerns a heart transplant patient with hypercholesterolemia who showed rapid development of a severe transplant coronary artery disease. The patient received 10 mg pravastatine per day. Quantitative coronary angiography analyses of 4 serial angiograms clearly demonstrated that in the first 2.5 years following surgery, there was a rapid simultaneous progression in both the transplant coronary disease, involving the entire coronary system, and the development of segmental stenotic lesions. During one year of weekly heparin-mediated extracorporeal LDL-cholesterol precipitation (HELP) therapy in addition to diet and pravastatine therapy, the serum low density lipoprotein (LDL), lipoprotein (a) (Lp(a)), and fibrinogen levels could be reduced from 185 +/- 45 mg/dl, 138 mg/dl and 248 mg/dl, respectively, to interval values of 136 +/- 17 mg/dl, 48 +/- 15 mg/dl, and 185 +/- 44 mg/dl, respectively [interval value = (the concentration after HELP + the concentration before the next HELP treatment):2]. This therapy halted further progression of coronary diameter throughout the whole coronary system and brought about marked regression of segmental obstructive lesions.
Park
J W
JW
Herzzentrum Duisburg Kaiser-Wilhelm-Krankenhaus, Germany.
Vermeltfoort
M
M
Braun
P
P
May
E
E
Merz
M
M
D001161:Arteriosclerosis / Q000000981:diagnostic imaging / Q000503:physiopathology; D011232:Chemical Precipitation; D008078:Cholesterol, LDL / Q000097:blood* / Q000302:isolation & purification; D017023:Coronary Angiography; D003327:Coronary Disease / Q000097:blood* / Q000000981:diagnostic imaging / Q000628:therapy*; D005112:Extracorporeal Circulation; D005340:Fibrinogen / Q000378:metabolism; D005500:Follow-Up Studies; D016027:Heart Transplantation / Q000502:physiology*; D006801:Humans; D006937:Hypercholesterolemia / Q000628:therapy*; D017270:Lipoprotein(a) / Q000097:blood; D008297:Male; D008875:Middle Aged; D017035:Pravastatin / Q000627:therapeutic use; D013997:Time Factors
D008078:Cholesterol, LDL; D017270:Lipoprotein(a); D005340:Fibrinogen; D017035:Pravastatin