(Circulation. 1998;98:2672-2678.)
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports |
Development of Transplantation Vasculopathy and Progression of Donor-Transmitted Atherosclerosis
Comparison by Serial Intravascular Ultrasound Imaging
From The Cleveland Clinic Foundation, Cleveland, Ohio.
Correspondence to E.M. Tuzcu, MD, The Cleveland Clinic Foundation, F25, 9500 Euclid Ave, Cleveland, OH 44195.
Background—Transplant coronary artery disease is a combination of atherosclerosis transmitted from the donor and new lesions of allograft vasculopathy. We sought to determine the morphological characteristics of allograft vasculopathy and differentiate it from donor-transmitted atherosclerosis with serial intravascular ultrasound.
Methods and Results—Intravascular ultrasound examination
was performed in 93 patients at 27.2±15.0 and 369.7±23.9 days after
transplantation. The maximally and minimally diseased sites were
selected in each segment as defined by Coronary Artery Surgery
Study classification. For each matched site, maximal plaque thickness
was measured. Lesions (maximum plaque thickness 
0.5 mm)
present at baseline examination were defined as donor lesions. On
follow-up, lesions that developed at previously normal sites were
defined as de novo lesions. The distribution and severity of donor and
de novo lesions were similar in proximal, mid, and distal segments. The
de novo lesions were less focal (43% vs 74%) and more circumferential
(69% vs 45%) compared with the donor lesions, but there was
significant morphological heterogeneity. Similar
numbers of patients with and those without donor lesions developed de
novo lesions. Moreover, progression of donor lesions was not associated
with the presence or absence of de novo lesions.
Conclusions—Differentiation between early allograft vasculopathy from conventional atherosclerosis by distribution and morphology of lesions alone is difficult. Serial intravascular ultrasound imaging with early baseline examination is necessary to make this distinction. This distinction is important because the progression of donor lesions and the development of de novo lesions are independent of each other.
Key Words: coronary artery disease • transplantation • ultrasonics • lesion
This article has been cited by other articles:
 |
|
 |
|
  H. Li, K. Tanaka, H. Anzai, B. Oeser, D. Lai, J. A. Kobashigawa, and J. M. Tobis Influence of Pre-Existing Donor Atherosclerosis on the Development of Cardiac Allograft Vasculopathy and Outcomes in Heart Transplant Recipients J. Am. Coll. Cardiol., June 20, 2006; 47(12): 2470 - 2476. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M.-K. Hong, G. S. Mintz, C. W. Lee, B.-K. Lee, T.-H. Yang, Y.-H. Kim, J.-M. Song, K.-H. Han, D.-H. Kang, S.-S. Cheong, et al. The Site of Plaque Rupture in Native Coronary Arteries: A Three-Vessel Intravascular Ultrasound Analysis J. Am. Coll. Cardiol., July 19, 2005; 46(2): 261 - 265. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Kato, M. C. Y. Chan, S.-Z. Gao, J. S. Schroeder, M. Yokota, T. Murohara, M. Iwase, A. Noda, S. A. Hunt, and H. A. Valantine Glucose intolerance, as reflected by hemoglobin a1c level, is associated with the incidence and severity of transplant coronary artery disease J. Am. Coll. Cardiol., March 17, 2004; 43(6): 1034 - 1041. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. J. Eisen, E. M. Tuzcu, R. Dorent, J. Kobashigawa, D. Mancini, H. A. Valantine-von Kaeppler, R. C. Starling, K. Sorensen, M. Hummel, J. M. Lind, et al. Everolimus for the Prevention of Allograft Rejection and Vasculopathy in Cardiac-Transplant Recipients N. Engl. J. Med., August 28, 2003; 349(9): 847 - 858. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. Mancini, S. Pinney, D. Burkhoff, J. LaManca, S. Itescu, E. Burke, N. Edwards, M. Oz, and A. R. Marks Use of Rapamycin Slows Progression of Cardiac Transplantation Vasculopathy Circulation, July 8, 2003; 108(1): 48 - 53. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. Vassalli, A. Gallino, M. Weis, W. von Scheidt, L. Kappenberger, L.K. von Segesser, J.-J. Goy, and on behalf of the Working Group Microcirculation of Alloimmunity and nonimmunologic risk factors in cardiac allograft vasculopathy Eur. Heart J., July 1, 2003; 24(13): 1180 - 1188. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Weis, S. Pehlivanli, B. M. Meiser, and W. von Scheidt Simvastatin treatment is associated with improvement in coronary endothelial function and decreased cytokine activation in patients after heart transplantation J. Am. Coll. Cardiol., September 1, 2001; 38(3): 814 - 818. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Tsutsui, K. M. Ziada, P. Schoenhagen, A. Iyisoy, W. A. Magyar, T. D. Crowe, J. D. Klingensmith, D. G. Vince, G. Rincon, R. E. Hobbs, et al. Lumen Loss in Transplant Coronary Artery Disease Is a Biphasic Process Involving Early Intimal Thickening and Late Constrictive Remodeling: Results From a 5-Year Serial Intravascular Ultrasound Study Circulation, August 2, 2001; 104(6): 653 - 657. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Schoenhagen, K. M. Ziada, D. G. Vince, S. E. Nissen, and E. M. Tuzcu Arterial remodeling and coronary artery disease: the concept of "dilated" versus "obstructive" coronary atherosclerosis J. Am. Coll. Cardiol., August 1, 2001; 38(2): 297 - 306. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. M. Tuzcu, S. R. Kapadia, E. Tutar, K. M. Ziada, R. E. Hobbs, P. M. McCarthy, J. B. Young, and S. E. Nissen High Prevalence of Coronary Atherosclerosis in Asymptomatic Teenagers and Young Adults : Evidence From Intravascular Ultrasound Circulation, June 5, 2001; 103(22): 2705 - 2710. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Tsimikas, W. Palinski, and J. L. Witztum Circulating Autoantibodies to Oxidized LDL Correlate With Arterial Accumulation and Depletion of Oxidized LDL in LDL Receptor-Deficient Mice Arterioscler Thromb Vasc Biol, January 1, 2001; 21(1): 95 - 100. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K Pethig, V Klauss, B Heublein, H Mudra, A Westphal, C Weber, K Theisen, and A Haverich Progression of cardiac allograft vascular disease as assessed by serial intravascular ultrasound: correlation to immunological and non-immunological risk factors Heart, November 1, 2000; 84(5): 494 - 498. [Abstract] [Full Text]
|
|
|
|
|
|
S. Fateh-Moghadam, W. Bocksch, A. Ruf, T. Dickfeld, M. Schartl, G. Pogatsa-Murray, R. Hetzer, E. Fleck, and M. Gawaz Changes in Surface Expression of Platelet Membrane Glycoproteins and Progression of Heart Transplant Vasculopathy Circulation, August 22, 2000; 102(8): 890 - 897. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. D. Knollmann, W. Bocksch, S. Spiegelsberger, R. Hetzer, R. Felix, and M. Hummel Electron-Beam Computed Tomography in the Assessment of Coronary Artery Disease After Heart Transplantation Circulation, May 2, 2000; 101(17): 2078 - 2082. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. P. Schwarzacher, N. G. Uren, M. R. Ward, A. Schwarzkopf, N. Giannetti, S. Hunt, P. J. Fitzgerald, S. N. Oesterle, and A. C. Yeung Determinants of Coronary Remodeling in Transplant Coronary Disease : A Simultaneous Intravascular Ultrasound and Doppler Flow Study Circulation, March 28, 2000; 101(12): 1384 - 1389. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. B. Young Allograft Vasculopathy : Diagnosing the Nemesis of Heart Transplantation Circulation, August 3, 1999; 100(5): 458 - 460. [Full Text] [PDF]
|
|