Patterns of myocardial endothelin-1 expression and outcome after cardiac transplantation.
BACKGROUND
Endothelin-1 (ET-1), a potent vasoconstrictor, is released in response to several inflammatory cytokines after heart transplantation. The present study correlated patterns of myocardial ET-1 expression in heart biopsies with acute rejection, post-transplantation ischemic injury, and subsequent development of coronary vasculopathy.


RESULTS
Patterns of myocardial ET-1 expression were evaluated in 47 heart transplant recipients at 3 months after transplant. Transplant vasculopathy was documented by coronary angiography at 2 years after transplant. Expression of ET-1 was tabulated for both blood vessels and the interstitium. Vascular ET-1 expression was positive in 7/17 (41%) of patients with greater than grade 2 (International Society Heart Lung Transplant) rejection compared with 3/30 (10%) of patients with grade 0 and grade 1A rejection (P=0.02). Compared with patients with negative interstitial ET-1 expression (n=22), patients with positive interstitial ET-1 expression (n=25) had higher incidence of post-transplantation ischemic injury (52% versus 9%, P=0.002), lower mean episodes of acute rejection (> or = grade 2) during the first 3 months of transplant (1.09+/-0.66 versus 1.86+/-1.6, P=0.048), and more common vasculopathy at 2 years (50% versus 15%, P=0.02), and they tended to have worse survival (83.2% versus 100%, P=0.058).


CONCLUSIONS
Vascular ET-1 expression is likely to be associated with acute rejection. Interstitial ET-1 expression, however, is more likely to be associated with post-transplantation ischemic injury and subsequent development of coronary vasculopathy.
Ferri
Claudio
C
University of L'Aquila, Department of Internal Medicine and Public Health, Italy.
Properzi
Giuliana
G
Tomassoni
Gianluca
G
Santucci
Anna
A
Desideri
Giovambattista
G
Giuliani
Anna Elisa
AE
Starling
Randall C
RC
Ratliff
Norman B
NB
Cook
Daniel J
DJ
McCarthy
Patrick
P
Young
James B
JB
Yamani
Mohamad H
MH
D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000209:etiology / Q000378:metabolism; D003331:Coronary Vessels / Q000378:metabolism; D019332:Endothelin-1 / Q000378:metabolism*; D006084:Graft Rejection / Q000378:metabolism; D016027:Heart Transplantation / Q000009:adverse effects / Q000000981:diagnostic imaging / Q000401:mortality; D006801:Humans; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging / Q000209:etiology / Q000378:metabolism; D009206:Myocardium / Q000378:metabolism*; D015996:Survival Rate; D016896:Treatment Outcome
D019332:Endothelin-1