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Published on: April 19, 2017
Plasma atherogenic markers in congestive heart failure and posttransplant (heart) patients
G E Cooke1, G M Eaton, G Whitby
1The Heart and Lung Institute, Department of Internal Medicine, College of Medicine and Public Health, The Ohio State University, Columbus 43210, USA.
Insights
Cardiac allograft vasculopathy (CAV) is linked to increased atherogenic factors post-transplant, similar to pre-existing conditions in heart failure patients. Lower folate levels correlate with CAV severity, suggesting multifactorial causes.
Area of Science:
- Cardiology
- Transplantation Immunology
- Vascular Biology
Background:
- Cardiac allograft vasculopathy (CAV) is a significant cause of mortality in heart transplant recipients.
- The pathogenesis of CAV remains poorly understood and shares similarities with atherosclerotic coronary disease.
- Identifying risk factors for CAV is crucial for improving long-term outcomes in heart transplant patients.
Purpose of the Study:
- To investigate the role of plasma factors associated with atherosclerosis in the development of cardiac allograft vasculopathy (CAV).
- To compare atherogenic markers in heart transplant recipients with and without CAV to control groups.
Main Methods:
- The study included 93 heart transplant recipients and control groups of 31 patients with congestive heart failure (CHF) and 18 healthy individuals.
- Coronary anatomy was assessed using angiography and intravascular ultrasound.
- Laboratory analyses included lipids, homocysteine, vitamin B12, folate, fibrinogen, von Willebrand factor antigen (vWFAg), and renin.
Main Results:
- Post-transplant patients exhibited elevated triglycerides, total cholesterol/HDL ratio, lipoprotein (a), homocysteine, vWFAg, fibrinogen, and renin, with lower HDL cholesterol.
- Many atherogenic factors were also elevated in the CHF control group.
- CAV severity correlated with time post-transplant, statin use, and prior cytomegalovirus infection; lower RBC folate levels were associated with increased CAV severity.
Conclusions:
- The post-transplant period is characterized by increased atherogenic factors that likely contribute to coronary vasculopathy severity.
- Many of these atherogenic markers are elevated in pre-transplant CHF patients, suggesting a predisposition.
- Further research is needed to elucidate the complex interplay of factors contributing to CAV progression.
Objectives:
We hypothesized that plasma factors important for the development of atherosclerosis play a major role in the occurrence of cardiac allograft vasculopathy (CAV).
Background:
Cardiac allograft vasculopathy is a major cause of death among heart transplant recipients, has a poorly understood pathogenesis and has similarities to atherosclerotic coronary disease.
Methods:
The study population consisted of 93 postcardiac transplant recipients. Thirty-one patients with congestive heart failure (CHF) and 18 healthy individuals served as control subjects. Posttransplant coronary anatomy was evaluated by angiography and intravascular ultrasound. Laboratory analyses of lipids, homocysteine, vitamin B12 and folate, fibrinogen, von Willebrand factor antigen (vWFAg) and renin were obtained on all participants.
Results:
Posttransplant patients were found to have elevated serum triglycerides, total cholesterol/ high-density lipoprotein cholesterol ratio, lipoprotein (a), homocysteine, vWFAg, fibrinogen and renin and lower high-density lipoprotein cholesterol. Most of these laboratory atherogenic factors were also elevated to a similar degree in the CHF control population. Although most atherogenic markers were elevated, there was little correlation with CAV severity. Cardiac allograft vasculopathy severity varied with time after transplantation, 3-hydroxy-methyl-glutaryl-coenzyme A reductase inhibitor use and prior cytomegalovirus infection. Even within the normal range, lower RBC folate levels were associated with increased severity of CAV.
Conclusions:
The posttransplant course is associated with increased clinical and laboratory atherogenic factors, some of which likely contribute to the severity of coronary vasculopathy. Compared with normal control subjects, many of these markers are already increased in pretransplant CHF patients with or without occlusive coronary artery disease.
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