title: Coronary plaque morphologic characteristics early and late after heart transplantation: in vivo analysis with intravascular ultrasonography.
abstract: To characterize plaque morphologic characteristics of transplant coronary artery disease early and late after cardiac transplantation, 72 patients were studied with intravascular ultrasonography during routine coronary angiography (group 1, 25 patients < or = 2 months after surgery; group 2, 47 patients > or = 12 months after surgery). Both groups had comparable baseline characteristics. Three hundred fifty-one segments were imaged in 127 coronary arteries (4.9 +/- 1.8 segments per patient). By intravascular ultrasonography, relevant intimal thickening (> 0.3 mm) was found in the majority of patients (68% for group 1 and 72% for group 2). Angiography detected abnormal findings in only 16% and 32% for groups 1 and 2, respectively. Mean intimal index was higher in patients late after transplantation (27% +/- 12% vs 17% +/- 12%, respectively; p < 0.01). Maximal and mean plaque thickness were comparable in both groups, whereas a higher mean plaque circumference was found in group 2 (278 +/- 66 degrees vs 211 +/- 75 degrees, respectively; p < 0.002). The lesions were more eccentric in patients early after transplantation (mean eccentricity index 95% +/- 7% vs 77% +/- 15%, respectively; p < 0.0001). Diffuse, concentric intimal thickening was not a common pattern. Maximal plaque thickness correlated with donor age (r = 0.50, p < 0.0001). Coronary lesions were frequent even early after transplantation, with predominantly eccentric plaque morphologic characteristics indicative of preexisting atherosclerosis. Later after transplantation, a more homogeneous plaque distribution was seen, partly with diffuse concentic intimal thickening. Late transplant coronary artery disease appears to be a combination of preexisting native and acquired immune-mediated coronary artery disease.
authors.affiliation: Department of Internal Medicine, Klinikum Innenstadt, University of Munich, Germany.
authors.forename: V
authors.initials: V
authors.lastname: Klauss
authors.forename: K
authors.initials: K
authors.lastname: Ackermann
authors.forename: C H
authors.initials: CH
authors.lastname: Spes
authors.forename: T
authors.initials: T
authors.lastname: Zeitlmann
authors.forename: K H
authors.initials: KH
authors.lastname: Henneke
authors.forename: F
authors.initials: F
authors.lastname: Werner
authors.forename: E
authors.initials: E
authors.lastname: Regar
authors.forename: P
authors.initials: P
authors.lastname: Uberfuhr
authors.forename: K
authors.initials: K
authors.lastname: Theisen
authors.forename: H
authors.initials: H
authors.lastname: Mudra
mesh_terms: D000328:Adult; D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging* / Q000473:pathology*; D005260:Female; D016027:Heart Transplantation / Q000000981:diagnostic imaging* / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D014463:Ultrasonography