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Longitudinal study of vascular remodeling in coronary arteries after heart transplantation
J Kobashigawa1, L Wener, J Johnson
1Division of Cardiology/Department of Medicine, University of California, Los Angeles Medical Center, Los Angeles, California, USA.
Insights
Vascular remodeling, including vessel shrinkage, is common after heart transplant. This study shows constrictive remodeling occurs early and progresses over three years, despite decreasing intimal area after the first year.
Area of Science:
- Cardiovascular Research
- Transplant Cardiology
- Vascular Biology
Background:
- Previous cross-sectional studies using intravascular ultrasound (IVUS) suggested vascular remodeling in heart transplant recipients.
- Limited prospective data exists on vascular remodeling using comprehensive morphometric analysis in a single cohort.
Purpose of the Study:
- To prospectively evaluate vascular remodeling in coronary arteries of heart transplant recipients over three years.
- To assess changes in luminal area and intimal parameters using detailed morphometric analysis.
Main Methods:
- Prospective analysis of 20 heart transplant recipients using IVUS.
- Morphometric analysis of 10 evenly spaced images from the left anterior descending coronary artery at 2 months, 1, 2, and 3 years post-transplant.
- Evaluation of luminal area, intimal thickness, intimal index, and plaque area over time.
Main Results:
- Coronary artery luminal area significantly decreased from 12.0 mm² at baseline to 9.7 mm² at 3 years (p = 0.02), with shrinkage observed in 16/20 patients.
- Intimal parameters initially increased by Year 1, then significantly decreased between Year 1 and Year 3.
- Plaque area decreased from 2.05 mm² at 1 year to 1.48 mm² by 3 years (p = 0.05).
Conclusions:
- Early intimal thickening in the first year post-heart transplant is associated with constrictive remodeling.
- Constrictive remodeling continues over the subsequent two years, even with a reduction in intimal area.
- Morphometric analysis reveals significant vascular remodeling in heart transplant recipients over a three-year period.
Abstract:
Cross-sectional studies by intravascular ultrasound (IVUS) in heart transplant recipients have suggested that vascular remodeling occurs in coronary arteries years after transplant. However, no reports describe vascular remodeling in the same cohort of patients studied prospectively using morphometric analysis (10 evenly spaced images obtained from a slow pullback from the left anterior descending coronary artery). Morphometric analysis better reflects total vessel anatomy compared with previously reported site (2 to 3 images) analysis. We reviewed 20 patients studied by IVUS at 2 months, 1 year, 2 years, and 3 years after heart transplant.Over time, the coronary artery luminal area decreased from baseline level of 12.0 mm(2) to a 3-year mark of 9.7 mm(2) (p = 0.02). Vessel shrinkage was seen in 16/20 patients. After an initial rise in intimal parameters (maximal intimal thickness, intimal index, and plaque area) from baseline to 1 year, we found a significant decrease in intimal parameters between Year 1 and Year 3 after transplant. For example, plaque area decreased from 2.05 mm(2) at 1 year post-transplant to 1.48 mm(2) by 3 years post-transplant (p = 0.05). In a majority of heart transplant patients, early intimal thickening in the first year post-transplant is accompanied by constrictive remodeling. Over the subsequent 2 years, further constrictive remodeling is seen despite a decrease in intimal area.