Related Experiment Videos
Physiologic assessment of the coronary collateral circulation in transplanted human hearts
T H Johnson1, G S Das, A L McGinn
1Department of Medicine, University of Minnesota, Minneapolis.
Insights
Transplanted heart arteries with vasculopathy develop normal collateral circulation, similar to native arteries. This study measured coronary artery occlusion pressure to assess collateral function in heart transplant recipients.
Area of Science:
- Cardiology
- Transplantation Medicine
- Vascular Biology
Background:
- Heart transplant recipients often develop allograft vasculopathy, a condition causing coronary artery narrowing.
- Previous angiographic studies suggested impaired collateral vessel development in transplanted hearts with vasculopathy.
Purpose of the Study:
- To investigate the extent of collateral circulation in transplanted hearts with significant coronary stenosis.
- To compare collateral circulation in transplanted hearts with allograft vasculopathy to native coronary arteries with atherosclerotic disease.
Main Methods:
- Coronary artery occlusion pressure was measured during balloon angioplasty in heart transplant recipients and patients with atherosclerotic disease.
- Pressure measurements were taken distal to the stenosis during sustained balloon occlusion.
- Quantitative angiography assessed stenosis severity, and measurement reproducibility was evaluated.
Main Results:
- Stenosis severity was comparable between transplanted and native coronary arteries.
- Coronary occlusion pressure measurements were highly reproducible.
- Collateral circulation, indicated by coronary occlusion pressure, was nearly identical in transplanted hearts (32 ± 4 mm Hg) and native hearts (29 ± 2 mm Hg), even after exclusions and hemodynamic corrections.
Conclusions:
- Transplanted hearts with allograft vasculopathy demonstrate normal collateral circulation development.
- The findings challenge the previous assumption of inadequate collateralization in transplanted hearts with vasculopathy.
Abstract:
Coronary arteries of transplanted hearts frequently develop a vasculopathy characterized by severe lumenal narrowing in the distal coronary arteries. It has been thought, on the basis of angiographic studies, that the coronary circulation of transplanted hearts with vasculopathy fails to develop collateral vessels normally. To determine the extent of the collateral circulation in transplanted hearts with a significant coronary stenosis, we measured an index of the collateral circulation, the coronary artery occlusion pressure, during single-vessel coronary angioplasty in seven patients with allograft vasculopathy and 18 patients with atherosclerotic disease who did not undergo transplantation. Aortic and coronary artery pressure distal to the stenosis in the epicardial artery were measured during balloon occlusion (> or = 45 seconds). Measurement variability for determination of coronary occlusion pressure was assessed by measuring occlusion pressure on two separate balloon inflations (n = 17). The severity of the dilated stenotic lesion was assessed with quantitative angiography (Reiber-PIE Data method). The indexes of stenosis severity were similar in coronary arteries of transplanted and native hearts. Coronary occlusion pressure measurements were highly reproducible (mean absolute difference between measurements, 1 +/- 1 mm Hg, r = 0.98). Coronary occlusion pressure in transplanted hearts (32 +/- 4 mm Hg) was nearly identical to that measured in coronary arteries of native hearts (29 +/- 2 mm Hg). When vessels with total occlusion were excluded and corrections were made for minor differences in hemodynamics (heart rate and blood pressure) were made, the coronary occlusion pressure in transplanted hearts remained nearly identical to native hearts.(ABSTRACT TRUNCATED AT 250 WORDS)