Angiographic, intravascular ultrasound and functional findings early after orthotopic heart transplantation
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S Kerber1, A Rahmel, O Heinemann-Vechtel
1Department of Cardiology and Angiology, Hospital of the Westfälische Wilhelms-University of Münster, Germany.
Insights
Accelerated graft atherosclerosis in heart transplant recipients is common. Intravascular ultrasound detects early coronary artery changes and abnormal vasomotion, even before angiography shows significant lesions.
Area of Science:
- Cardiology
- Transplant Medicine
- Vascular Biology
Background:
- Accelerated graft atherosclerosis significantly increases mortality and morbidity in heart transplant recipients.
- Early detection of coronary atherosclerotic vessel alterations and endothelial dysfunction is crucial for patient outcomes.
Purpose of the Study:
- To evaluate coronary atherosclerotic vessel alterations using intravascular ultrasound.
- To assess endothelial function via acetylcholine infusion in heart transplant recipients.
Main Methods:
- Seventeen heart transplant recipients underwent biplane ventriculography, coronary angiography, and intravascular ultrasound.
- Acetylcholine infusion was used to evaluate vasomotion in the left anterior descending artery.
Main Results:
- Intravascular ultrasound detected intimal thickening in 52 segments, with a mean thickness of 0.35 mm.
- Angiography showed atherosclerotic lesions in only 5 of these segments.
- Abnormal coronary vasoconstriction in response to acetylcholine was observed in 10 of 13 patients, independent of ultrasound or angiographic findings.
Conclusions:
- Intravascular ultrasound can depict early-stage coronary artery lesions in heart transplant recipients.
- Most recipients exhibit abnormal endothelial function (vasoconstriction) in response to acetylcholine.
- These vascular abnormalities are detectable before significant angiographic changes occur.
Abstract:
Accelerated graft atherosclerosis is responsible for increased mortality and morbidity among heart transplant recipients. The aim of this in-vivo study was to evaluate coronary atherosclerotic vessel alterations and endothelial function. Seventeen patients (14 males; mean age 49.3 years; range 24 to 69) were studied an average of 11 weeks (range 5 to 21) after heart transplantation because of coronary artery disease (n = 8), dilative cardiomyopathy (n = 7), mitral valve replacement (n = 1) and left atrial metastases of a leiomyosarcoma (n = 1). Mean age of the donor hearts (9 males) was 29 years (range 12 to 55). All recipients underwent biplane ventriculography and coronary angiography. In this study population, a total of 120 coronary segments (main stem, 21; left anterior descending artery, 85; circumflex artery, 14) were analyzed by intravascular ultrasound (20 MHz, 3.5F). In 13 patients, acetylcholine was infused into the proximal left anterior descending artery (10(-8) to 10(-5) M) to evaluate vasomotion within this segment. Regional contraction abnormalities were documented in 2 patients. Nine segments angiographically showed non-critical stenoses (5 patients). Intravascular ultrasound detected 52 cross-sectional areas with a three-layer pattern indicating intimal thickening. Mean circumferential extension of intimal proliferation was 192 degrees, mean intimal thickness 0.35 mm. Only 5 segments of the sonographically pathological cross-sectional areas showed angiographical evidence of atherosclerotic lesions. Intracoronary administration of acetylcholine at doses of 10(-8) and 10(-7) M resulted in vasoconstriction of the examined coronary segment in only 2 patients; the intracoronary application of acetylcholine at doses of 10(-6) and 10(-5) M revealed coronary vasoconstriction in 10 of the total of 13 patients. Using intravascular ultrasound, coronary artery lesions in heart transplant recipients can already be depicted at a very early stage. The abnormal response to acetylcholine in most of the heart recipients is independent of the extent of atherosclerotic vessel abnormalities documented by ultrasound or angiography.