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(Circulation. 2000;101:1384.)
© 2000 American Heart Association, Inc.

Clinical Investigation and Reports

Determinants of Coronary Remodeling in Transplant Coronary Disease

A Simultaneous Intravascular Ultrasound and Doppler Flow Study

Severin P. Schwarzacher, MD; Neal G. Uren, MD; Michael R. Ward, MBBS, PhD; Anne Schwarzkopf, BA; Nadia Giannetti, MD; Sharon Hunt, MD; Peter J. Fitzgerald, MD, PhD; Stephen N. Oesterle, MD; Alan C. Yeung, MD

From the Division of Cardiology, Stanford University Medical Center.

Correspondence to Alan C. Yeung, MD, Division of Cardiology, Stanford University Medical Center, 300 Pasteur Dr, Stanford, CA 94305. E-mail alan_yeung{at}cvmed.stanford.edu

Background—Coronary remodeling plays a significant role in lumen loss in transplant allograft vasculopathy (TxCAD), but the determinants of remodeling are unknown. We assessed the relationship between remodeling and plaque topography, coronary compliance, and blood flow in TxCAD.

Methods and Results—One artery in each of 27 transplant patients was investigated with simultaneous intravascular ultrasound and coronary flow measurements (basal and hyperemic by Doppler flow wire). At 4 to 8 different cross sections (mean 5.1±1.2), plaque topography (concentric or eccentric) was determined, and total vessel area, lumen area, and intimal/medial area (IMA) were measured. Mean remodeling ratio (vessel area/IMA) in eccentric lesions (E, n=28) was significantly larger than that in concentric lesions (C, n=70) (E 5.87±0.93 versus C 3.58±0.62; P<0.001), despite similar IMA (E 3.89±0.68 versus C 3.90±0.41; P=NS) and distribution of imaged segments. Remodeling ratio was consistently larger in eccentric lesions in all 3 vessel segments when analyzed separately, and mean remodeling ratio for each artery was larger in vessels with predominantly eccentric lesions. Coronary compliance ([ lumen area/diastolic lumen area]/ mean arterial pressurex10³) was also significantly greater in eccentric lesions versus concentric lesions (proximal 1.00±0.39 versus 0.22±0.04; mid 0.71±0.17 versus 0.21±0.10; distal 0.43±0.13 versus 0.01±0.08; all P<0.01). Coronary flow reserve was also significantly higher in coronary arteries with primarily eccentric lesions (E 2.49±0.64 versus C 1.87±0.28; P<0.01).

Conclusions—Vessel remodeling in transplant vasculopathy is significantly greater in eccentric lesions than in concentric lesions, possibly due to greater coronary compliance and resistive vessel function.

Key Words: transplantation • remodeling • plaque • blood flow

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