Circulation, Vol 85, 69-77, Copyright © 1992 by American Heart Association
FJ Pinto, FG St. Goar, TA Fischell, ML Stadius, HA Valantine, EL Alderman and RL Popp
BACKGROUND. Coronary artery vasomotion is altered after cardiac
transplantation. The impact of accelerated transplant coronary
atherosclerosis and myocardial rejection on vasomotion is not well
understood. Intravascular ultrasound is a new imaging method with the
ability to study real-time changes in coronary artery dimensions. METHODS
AND RESULTS. Epicardial coronary artery response to nitroglycerin was
studied in 32 cardiac transplant recipients (age, 47 +/- 11 years) 3 weeks
to 10 years after transplantation with intracoronary ultrasound.
Cross-sectional luminal area and diameter were measured at a fixed position
in the left anterior descending artery immediately before and every 30
seconds for 5 minutes after 0.4 mg of sublingual nitroglycerin.
Cross-sectional area increased from a baseline of 13.1 +/- 3.9 mm2 to 15.8
+/- 3.9 mm2 at maximal vasodilation; luminal diameter increased from 4.0
+/- 0.6 mm to 4.5 +/- 0.6 mm. This increase reached statistical
significance (p less than 0.001) at 1.5 minutes after administration of
nitroglycerin; mean maximum increase occurred at 4.5 minutes (24% for
cross-sectional area and 11% for luminal diameter). Patients with
biopsy-proven mild or moderate concurrent rejection had a significantly
blunted vasodilatory response versus the nonrejection group (9% versus 27%
for cross- sectional area, p less than 0.04), although a vasodilatory
effect was still present. Nitroglycerin response was well preserved in
patients up to 10 years after transplantation; however, there was a trend
toward a decreased response in patients studied immediately after
transplantation (21% versus 29%, p = 0.37). Coronary intimal thickness, as
measured by ultrasound, had no impact on the vasodilatory response (R =
0.23, p = 0.34). CONCLUSIONS. Vasodilatory response to nitroglycerin in
cardiac transplant recipients is attenuated during episodes of cardiac
rejection. This response is preserved in long-term survivors and is
independent of the degree of intimal thickening. Intravascular ultrasound
provides a new method to document real-time epicardial coronary vasomotion.
ARTICLES
Nitroglycerin-induced coronary vasodilation in cardiac transplant recipients. Evaluation with in vivo intracoronary ultrasound
Stanford University School of Medicine, Division of Cardiovascular Medicine, CA 94305.
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