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Transplant coronary artery disease: histopathologic correlations with angiographic morphology
D E Johnson1, E L Alderman, J S Schroeder
1Department of Pathology, Stanford University Medical Center, California 94305.
Insights
Cardiac transplant recipients face accelerated coronary artery disease. Histology reveals this disease often shows fibrous intimal thickening, and angiography may underestimate mild narrowing.
Area of Science:
- Cardiology
- Transplant Medicine
- Pathology
Background:
- Accelerated coronary artery disease (CAD) is a significant cause of death and illness in heart transplant recipients.
- Understanding the relationship between angiographic findings and actual coronary artery pathology is crucial for patient management.
Purpose of the Study:
- To correlate the angiographic appearance of coronary arteries with their histologic features in patients with early graft dysfunction.
- To assess the accuracy of coronary angiography in detecting and grading the severity of transplant-associated coronary artery disease.
Main Methods:
- Analysis of coronary angiograms and corresponding histologic specimens from 10 cardiac transplant recipients who experienced early graft failure.
- Direct comparison of angiographic findings (lesion type, degree of narrowing) with light microscopy results of coronary artery segments.
Main Results:
- Angiographically normal segments frequently showed mild to moderate fibrous intimal thickening (73%).
- Discrete stenoses correlated with lipid-rich or atheromatous plaques, while diffuse narrowing indicated severe fibrous intimal thickening.
- Thrombus was common in discrete lesions and caused complete occlusions.
- Angiography accurately reflected high-grade stenoses but often underestimated lesions with less than 25% diameter narrowing.
Conclusions:
- Transplant coronary artery disease exhibits diverse histologic and angiographic characteristics.
- Coronary angiography may underestimate the severity of early-stage transplant CAD, particularly mild intimal thickening.
Abstract:
Accelerated coronary artery disease is a major cause of morbidity and mortality among cardiac transplant recipients. Ten patients who died or underwent retransplantation within 2 months of coronary angiography had direct correlation of angiographic (normal discrete lesions, diffuse concentric narrowing) with histologic appearance of coronary arteries. Of the 26 angiographically normal segments, 73% showed mild to moderate fibrous intimal thickening by light microscopy. The remainder had intermediate lesions or atheromatous plaques. Discrete stenoses usually corresponded to lipid-rich intermediate or atheromatous disease. In contrast, angiographically diffuse, concentrically narrowed lesions usually were areas of severe fibrous intimal thickening. Fresh or organizing thrombus was most often associated with discrete lesions and accounted for all complete occlusions. Histologic and angiographic comparisons of the degree of luminal narrowing showed generally good correlation for high grade stenoses. Lesions graded as having less than 25% diameter narrowing were often underestimated angiographically as compared with histologic determinations. Transplant coronary artery disease has a heterogeneous histologic and angiographic appearance, with angiographic underestimation of disease in some patients.