Histological evidence of concomitant intramyocardial and epicardial vasculitis in necropsied heart allografts: a possible relationship with graft coronary arteriosclerosis.
BACKGROUND
The significance of medial lymphocytic vasculitis in intramural coronary vessels in heart transplantation is very poorly understood. This study was designed to identify histological evidence of an association between the presence of epicardial coronary lesions and the occurrence of intramyocardial vasculitis and/or myocardial ischemia.


METHODS
We analyzed the frequency of medial vasculitis and other myocardial histological alterations in a retrospective study of 24 human cardiac allografts from patients who died of ischemic heart disease and/or myocardial rejection.


RESULTS
Medial lymphocytic vasculitis in the myocardium was associated with vasculitis in the vasa vasorum of the epicardial coronary arteries and the presence of microfoci of acute myocardial infarction but was independent of the occurrence of myocardial fiber rejection. Chronic graft epicardial arteriopathy revealed two patterns of lesions. One pattern was similar to that of usual atherosclerosis, compromising mainly the proximal segments of the coronary artery, and was not associated with intramural vasculitis. The other pattern demonstrated diffuse involvement of the epicardial artery associated with vasculitis of its vasa vasorum and lymphocytic vasculitis of the intramural vessels. This second type of epicardial coronary lesion seemed to evolve to fibrotic arteries with thinned walls, frequently demonstrating aneurysmal dilatation with severe fibrosis of the adventitia and poor vasa vasorum.


CONCLUSIONS
Medial vasculitis affecting intramyocardial vessels is associated with adventitial epicardial coronary vasculitis in the transplanted heart. The process of vasculitis may be involved in the development of chronic graft arteriosclerosis and is associated with ischemic myocardial lesions, but seems independent of myocardial fiber rejection.
InCor (Heart Institute), São Paulo University Medical School, Brazil.
M L
ML
Higuchi
L A
LA
Benvenuti
L M
LM
Demarchi
P
P
Libby
D000208:Acute Disease; D000914:Antibodies, Viral / Q000032:analysis; D002908:Chronic Disease; D003165:Complement System Proteins / Q000378:metabolism; D003324:Coronary Artery Disease / Q000209:etiology / Q000473:pathology; D003331:Coronary Vessels / Q000737:chemistry / Q000473:pathology; D003587:Cytomegalovirus / Q000276:immunology; D005260:Female; D005340:Fibrinogen / Q000378:metabolism; D005455:Fluorescent Antibody Technique; D005629:Frozen Sections; D006084:Graft Rejection / Q000401:mortality; D016027:Heart Transplantation / Q000009:adverse effects / Q000276:immunology / Q000473:pathology*; D006801:Humans; D007124:Immunoenzyme Techniques; D007136:Immunoglobulins / Q000378:metabolism; D008297:Male; D017202:Myocardial Ischemia / Q000401:mortality; D009206:Myocardium / Q000166:cytology / Q000276:immunology; D011180:Postmortem Changes; D014657:Vasculitis / Q000150:complications / Q000473:pathology*
D000914:Antibodies, Viral; D007136:Immunoglobulins; D005340:Fibrinogen; D003165:Complement System Proteins