Coronary endothelial vasomotor function and vascular remodeling in heart transplant recipients randomized for tacrolimus or cyclosporine immunosuppression.
OBJECTIVE
This study aimed to compare changes in coronary endothelial function, systemic endothelin-1 (ET-1) levels, and vascular remodeling in heart transplant recipients randomized to cyclosporin A (CyA) or tacrolimus (Tac) immunosuppression.


BACKGROUND
Functional endothelial abnormalities and intimal thickening are sensitive measures of early cardiac allograft vasculopathy (CAV).


METHODS
The randomized, prospective study was performed in two groups of 22 patients, maintained on Tac or CyA and mycophenolate mofetil immunosuppression, 1 and 12 months after heart transplantation. We investigated epicardial luminal diameter, coronary blood flow velocity, and ET-1 plasma levels at 1 and 12 months after transplantation. Structural coronary alterations were determined using intravascular ultrasound.


RESULTS
Epicardial vasomotor function at baseline and during follow-up was comparable between the groups. Deterioration of microvascular endothelial function during follow-up was significantly enhanced in the CyA versus Tac group (p < 0.05). Circulating ET-1 concentration increased in the CyA group but significantly decreased over time in the Tac group (CyA +17% vs. Tac -25%; p < 0.05). The time-dependent increase in mean intimal area was significantly enhanced in the CyA versus Tac group, whereas the vessel area significantly increased during follow-up in the Tac compared with the CyA group.


CONCLUSIONS
Epicardial endothelial function is comparable between CyA- and Tac-treated patients. Microvascular endothelial function deteriorates more in CyA-treated patients, a finding that correlates with enhanced ET-1 concentration and an increased intimal area during follow-up. The mean vessel area in the Tac group increased over time, indicating positive vascular remodeling. Tac is superior to CyA with respect to microvascular endothelial function, intimal thickening, and vascular remodeling.
Petrakopoulou
Paraskevi
P
Medizinische Klinik und Poliklinik I, Ludwig-Maximilians University of Munich, Munich, Germany.
Anthopoulou
Lydia
L
Muscholl
Michael
M
Klauss
Volker
V
von Scheidt
Wolfgang
W
Uberfuhr
Peter
P
Meiser
Bruno M
BM
Reichart
Bruno
B
Weis
Michael
M
D000328:Adult; D000368:Aged; D001783:Blood Flow Velocity / Q000187:drug effects; D003326:Coronary Circulation / Q000187:drug effects; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000503:physiopathology*; D016572:Cyclosporine / Q000627:therapeutic use*; D019332:Endothelin-1 / Q000097:blood; D004730:Endothelium, Vascular / Q000503:physiopathology*; D005260:Female; D016027:Heart Transplantation; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009994:Osmolar Concentration; D010496:Pericardium / Q000503:physiopathology; D016559:Tacrolimus / Q000627:therapeutic use*; D017539:Tunica Intima / Q000000981:diagnostic imaging; D018084:Ultrasonography, Interventional; D014666:Vasomotor System / Q000187:drug effects*
D019332:Endothelin-1; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D016559:Tacrolimus