title: Tissue characterization of progressive cardiac allograft vasculopathy in patients with everolimus therapy compared with donor-transmitted atherosclerosis assessed using serial intravascular imaging: a case report.
abstract: Using serial intravascular ultrasound (IVUS), integrated-backscatter IVUS, and optical coherence tomography, we observed rapidly progressive cardiac allograft vasculopathy (CAV) and donor-transmitted plaque in the left anterior descending artery. Late-phase everolimus-resistant CAV had a rapidly progressive course (maximal intimal thickness [MIT] increased by 0.5 mm between years 3 and 4 after cardiac transplantation, from MIT growth<0.5 mm at year 1). Conversely, the donor-transmitted plaque grew slowly (0.1 mm increase during the same period). Tissue characteristics in the 2 segments were also different; CAV had eccentric, noncalcified, and lipid-rich components and was associated with macrophage accumulation, whereas donor-transmitted atherosclerosis presented with typical features of atherosclerosis (ie, fibrocalcific plaque). CAV with late-phase progression involves everolimus resistance and features of vulnerable plaques seen in nontransplantation patients and is independent of donor-transmitted atherosclerosis.
authors.affiliation: Department of Transplantation, National Cerebral and Cardiovascular Center, Osaka, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Watanabe
authors.affiliation: Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan. Electronic address: Shamallv8@aol.com.
authors.forename: J
authors.initials: J
authors.lastname: Kotani
authors.affiliation: Department of Transplantation, National Cerebral and Cardiovascular Center, Osaka, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Murata
authors.affiliation: Department of Transplantation, National Cerebral and Cardiovascular Center, Osaka, Japan.
authors.forename: O
authors.initials: O
authors.lastname: Seguchi
authors.affiliation: Department of Transplantation, National Cerebral and Cardiovascular Center, Osaka, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Yanase
authors.affiliation: Department of Transplantation, National Cerebral and Cardiovascular Center, Osaka, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Nakatani
mesh_terms: D064591:Allografts; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000209:etiology* / Q000473:pathology*; D003331:Coronary Vessels / Q000000981:diagnostic imaging; D018450:Disease Progression; D004351:Drug Resistance; D000068338:Everolimus; D016027:Heart Transplantation; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D058226:Plaque, Atherosclerotic / Q000473:pathology*; D020123:Sirolimus / Q000009:adverse effects / Q000031:analogs & derivatives; D014463:Ultrasonography
chemical_list: D007166:Immunosuppressive Agents; D000068338:Everolimus; D020123:Sirolimus