title: Increased coronary lipid accumulation in heart transplant recipients with prior high-grade cellular rejection: novel insights from near-infrared spectroscopy.
abstract: Cardiac allograft vasculopathy is a major cause of morbidity and mortality among patients after heart transplantation. We sought to assess the amount of lipid accumulation in the coronary arteries of transplant patients according to rejection grade. Overall, 39 consecutive heart transplant recipients undergoing annual routine surveillance coronary angiography underwent near-infrared spectroscopy and intravascular ultrasound imaging of 1 coronary artery. Rejection history was graded according to the International Society of Heart and Lung Transplantation (ISHLT) classification as none/mild/moderate-grade rejection (ISHLT 0, 1A/1B, or 2) compared to high-grade rejection (≥3A). Patients with prior history of high-grade rejection had larger plaque burden in the distal coronary segments [45.7 % (25.5-63.7) vs 25.1 % (19.9-37.8), p = 0.02] and a higher maximum lipid core burden index in any 4-mm long segment (maxLCBI(4mm)) [243 (91-400) vs 41 (1-170), p = 0.016] as compared with patients with prior history of none/mild/moderate-grade rejection. By multivariable linear regression analysis, prior history of high-grade rejection was an independent predictor for maxLCBI(4mm). A maxLCBI(4mm) >200 distinguished prior history of high-grade from none/mild/moderate rejection with a sensitivity of 61.5 % and specificity of 84.6 %. The current study demonstrates that the coronary arteries of post heart-transplant patients with a prior history of high-grade cellular rejection have increasing amounts of lipid-rich plaque. MaxLCBI(4mm) >200 might differentiate patients with previous high-grade cellular rejection from heart transplant recipients with none/mild/moderate-grade rejection.
authors.affiliation: NewYork-Presbyterian/Columbia University Medical Center, New York, NY, USA.|Cardiovascular Research Foundation, New York, NY, USA.|Peking University First Hospital, Peking University Health Science Center, Beijing, China.
authors.forename: Bo
authors.initials: B
authors.lastname: Zheng
authors.affiliation: NewYork-Presbyterian/Columbia University Medical Center, New York, NY, USA. amaehara@crf.org.|Cardiovascular Research Foundation, New York, NY, USA. amaehara@crf.org.
authors.forename: Akiko
authors.initials: A
authors.lastname: Maehara
authors.affiliation: Cardiovascular Research Foundation, New York, NY, USA.
authors.forename: Gary S
authors.initials: GS
authors.lastname: Mintz
authors.affiliation: NewYork-Presbyterian/Columbia University Medical Center, New York, NY, USA.|Cardiovascular Research Foundation, New York, NY, USA.
authors.forename: Tamim M
authors.initials: TM
authors.lastname: Nazif
authors.affiliation: NewYork-Presbyterian/Columbia University Medical Center, New York, NY, USA.
authors.forename: Yarden
authors.initials: Y
authors.lastname: Waksman
authors.affiliation: NewYork-Presbyterian/Columbia University Medical Center, New York, NY, USA.|Cardiovascular Research Foundation, New York, NY, USA.
authors.forename: Fuyu
authors.initials: F
authors.lastname: Qiu
authors.affiliation: NewYork-Presbyterian/Columbia University Medical Center, New York, NY, USA.
authors.forename: Luz
authors.initials: L
authors.lastname: Jaquez
authors.affiliation: NewYork-Presbyterian/Columbia University Medical Center, New York, NY, USA.
authors.forename: LeRoy E
authors.initials: LE
authors.lastname: Rabbani
authors.affiliation: NewYork-Presbyterian/Columbia University Medical Center, New York, NY, USA.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Apfelbaum
authors.affiliation: NewYork-Presbyterian/Columbia University Medical Center, New York, NY, USA.|Cardiovascular Research Foundation, New York, NY, USA.
authors.forename: Ziad A
authors.initials: ZA
authors.lastname: Ali
authors.affiliation: NewYork-Presbyterian/Columbia University Medical Center, New York, NY, USA.
authors.forename: Kate
authors.initials: K
authors.lastname: Dalton
authors.affiliation: NewYork-Presbyterian/Columbia University Medical Center, New York, NY, USA.|Cardiovascular Research Foundation, New York, NY, USA.|Fuwai Hospital, Bejing, China.
authors.forename: Lei
authors.initials: L
authors.lastname: Song
authors.affiliation: Cardiovascular Research Foundation, New York, NY, USA.
authors.forename: Ke
authors.initials: K
authors.lastname: Xu
authors.affiliation: NewYork-Presbyterian/Columbia University Medical Center, New York, NY, USA.
authors.forename: Charles C
authors.initials: CC
authors.lastname: Marboe
authors.affiliation: NewYork-Presbyterian/Columbia University Medical Center, New York, NY, USA.
authors.forename: Donna M
authors.initials: DM
authors.lastname: Mancini
authors.affiliation: NewYork-Presbyterian/Columbia University Medical Center, New York, NY, USA.|Cardiovascular Research Foundation, New York, NY, USA.|Department of Cardiology, Shaare Zedek Medical Center, 12 Shmuel (Hans) Beyth Street, Jerusalem, 91031, Israel.
authors.forename: Giora
authors.initials: G
authors.lastname: Weisz
mesh_terms: D000368:Aged; D003331:Coronary Vessels; D005260:Female; D006084:Graft Rejection; D016027:Heart Transplantation; D006801:Humans; D008055:Lipids / Q000032:analysis*; D008297:Male; D008875:Middle Aged; D058226:Plaque, Atherosclerotic / Q000175:diagnosis*; D019265:Spectroscopy, Near-Infrared
chemical_list: D008055:Lipids
keywords: Imaging; NIRS; Transplantation; Vasculature