title: Intraplaque hemorrhage in cardiac allograft vasculopathy.
abstract: Plaque hemorrhage, inflammation and microvessel density are key determinants of plaque vulnerability in native coronary atherosclerosis (ATS). This study investigates the role of intraplaque hemorrhage (IPH) and its relation with inflammation and microvessels in cardiac allograft vasculopathy (CAV) in posttransplanted patients. Seventy coronary plaques were obtained from 12 patients who died because of CAV. For each patient we collected both native heart and the allograft, at the time of transplantation and autopsy, respectively. Intralesion inflammation, microvessels and IPH were assessed semi-quantitatively. IPH was observed in 21/35 (60%) CAV lesions and in 8/35 (22.9%) native ATS plaques, with a strong association between fibrocellular lesions and IPH (p = 0.0142). Microvessels were detected in 26/35 (74.3%) of CAV lesions with perivascular leakage as sign of endothelial damage in 18/26 (69.2%). IPH was strongly associated with microvessels (p < 0.0001). Inflammation was present in 31/35 (88.6%) of CAV lesions. CAV IPH+ lesions were characterized by presence of both fresh and old hemorrhage in 12/21 (57.1%). IPH, associated with microvessel damage and inflammation, is an important feature of CAV. Fresh and old intralesion hemorrhage suggests ongoing remodeling processes promoting the lesion progression and vulnerability.
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Castellani
authors.forename: A
authors.initials: A
authors.lastname: Angelini
authors.forename: O J
authors.initials: OJ
authors.lastname: de Boer
authors.forename: C M
authors.initials: CM
authors.lastname: van der Loos
authors.forename: M
authors.initials: M
authors.lastname: Fedrigo
authors.forename: A C
authors.initials: AC
authors.lastname: Frigo
authors.forename: L B
authors.initials: LB
authors.lastname: Meijer-Jorna
authors.forename: X
authors.initials: X
authors.lastname: Li
authors.forename: H J P
authors.initials: HJ
authors.lastname: Ploegmakers
authors.forename: F
authors.initials: F
authors.lastname: Tona
authors.forename: G
authors.initials: G
authors.lastname: Feltrin
authors.forename: G
authors.initials: G
authors.lastname: Gerosa
authors.forename: M
authors.initials: M
authors.lastname: Valente
authors.forename: G
authors.initials: G
authors.lastname: Thiene
authors.forename: A C
authors.initials: AC
authors.lastname: van der Wal
mesh_terms: D000328:Adult; D064591:Allografts; D003324:Coronary Artery Disease / Q000473:pathology; D016027:Heart Transplantation / Q000009:adverse effects*; D006470:Hemorrhage / Q000473:pathology*; D006801:Humans; D007249:Inflammation / Q000209:etiology; D055806:Microvessels / Q000473:pathology; D008875:Middle Aged; D058226:Plaque, Atherosclerotic / Q000473:pathology*
keywords: Atherosclerosis; cardiac allograft vasculopathy; cardiac transplantation; inflammation; intraplaque hemorrhage; microvessels