title: Relevance of cytomegalovirus infection and coronary-artery remodeling in the first year after heart transplantation: a prospective three-dimensional intravascular ultrasound study.
abstract: BACKGROUND
  Transplant coronary artery disease (TxCAD) is a major cause of long-term mortality after heart transplantation. Although vascular remodeling has been implicated in the pathophysiology of TxCAD, its determinants remain unknown.
  
  
  METHODS
  Twenty-nine consecutive heart-transplant recipients prospectively received intravascular ultrasound (IVUS) of the left-anterior descending artery 1 and 12 months after transplant, with volumetric reconstruction of the proximal 30 mm.
  
  
  RESULTS
  Overall, patients exhibited intimal volume increase (+83%, P<0.001), wheras vessel volume remained largely unchanged (+4%, P=0.270); consequently, overall lumen volume decreased (-6%, P=0.058). Among the clinical and laboratory variables, cytomegalovirus (CMV) infection requiring treatment (occurring in 12 patients), as assessed by pp65 antigenemia, was independently associated with the impaired ability of the vessel wall to enlarge in response to intimal volume increase, ultimately resulting in lumen loss (OR [95% CI]=0.098 [0.010-0.920]; P=0.042). However, adequate vessel response to intimal hyperplasia with consequent lumen preservation was observed in the remaining 17 patients who did not present CMV infection requiring treatment.
  
  
  CONCLUSIONS
  The present study demonstrates that either adequate or inadequate coronary remodeling may occur during the first year after transplantation. Moreover, for the first time, it strongly suggests that remodeling modalities may be negatively influenced by the occurrence of clinically relevant CMV infection. Randomized prospective trials are warranted to investigate whether aggressive treatment of CMV infection may help prevent TxCAD.
authors.affiliation: Institute of Cardiology, Hospital S. Orsola-Malpighi, Bologna, Italy.
authors.forename: Luciano
authors.initials: L
authors.lastname: Potena
authors.forename: Francesco
authors.initials: F
authors.lastname: Grigioni
authors.forename: Paolo
authors.initials: P
authors.lastname: Ortolani
authors.forename: Gaia
authors.initials: G
authors.lastname: Magnani
authors.forename: Cinzia
authors.initials: C
authors.lastname: Marrozzini
authors.forename: Elena
authors.initials: E
authors.lastname: Falchetti
authors.forename: Alessandra
authors.initials: A
authors.lastname: Barbieri
authors.forename: Letizia
authors.initials: L
authors.lastname: Bacchi-Reggiani
authors.forename: Tiziana
authors.initials: T
authors.lastname: Lazzarotto
authors.forename: Antonio
authors.initials: A
authors.lastname: Marzocchi
authors.forename: Carlo
authors.initials: C
authors.lastname: Magelli
authors.forename: Maria P
authors.initials: MP
authors.lastname: Landini
authors.forename: Angelo
authors.initials: A
authors.lastname: Branzi
mesh_terms: D000328:Adult; D000368:Aged; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000821:virology*; D003586:Cytomegalovirus Infections / Q000000981:diagnostic imaging*; D019560:Echocardiography, Three-Dimensional; D005260:Female; D005500:Follow-Up Studies; D016027:Heart Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000821:virology; D011446:Prospective Studies