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Powered by the California Digital Library University of California Accelerated coronary atherosclerosis is the leading cause of long-term morbidity and mortality in heart transplant recipients. [1][2][3][4][5][6] Annual coronary angiography, which can detect severe transplantation coronary artery disease (TCAD) as early as 1 to 2 years after heart transplantation, has been used for diagnostic and surveillance purposes because patients may remain asymptomatic until myocardial infarction, congestive heart failure, cardiac arrhythmia, or sudden death develop. 3,7 Angiography is relatively insensitive for detecting early or less severe TCAD because of its diffuse nature and because the early phases of intimal hyperplasia may be associated with vessel wall expansion (positive remodeling) and minimal luminal narrowing. 8,9 The development of intravascular ultrasound (IVUS) has allowed more accurate and sensitive detection of coronary artery disease (CAD). [10][11][12] IVUS is also more sensitive in assessing allograft vasculopathy in patients who receive heart transplantation before angiographic changes have occurred. 13,14 The accuracy, reproducibility, and immediate safety of IVUS has been documented in both transplant recipients and in patients who have not undergone transplantation. 10,11,14 However, it is not known whether instrumentation of transplanted arteries affects progression of arteriopathy over several years. The purpose of this study was to examine if there was a correlation between performing IVUS examinations and the acceleration of TCAD. Methods Patient populationThe study population consisted of 95 patients who underwent heart transplantation at the University of California Los Angeles Medical Center between January 1991 and May 1995. Background Intravascular ultrasound (IVUS) is a sensitive method for assessing allograft vasculopathy in heart transplant recipients, but it is not known whether this instrumentation traumatizes the transplanted arteries and affects progression of arteriopathy. Methods and ResultsYearly coronary angiograms were obtained in 86 patients who underwent heart transplantation between January 1991 and May 1995. Patients were divided into 3 groups: (1) no IVUS performed after transplantation (group 1, n = 47); (2) IVUS of the left anterior descending artery (LAD) performed only at year 1 (group 2, n = 13); and (3) IVUS of the LAD performed at both baseline (within 2 months after transplantation) and year 1 after transplantation (group 3, n = 26). Coronary angiography measurements of lumen diameter were performed at 5 segments along the length of the LAD and left circumflex artery (LCX) from baseline through the second-year studies except in group 2, which did not receive a baseline angiogram; IVUS measurements were obtained at 10 cross sections from each artery. At baseline, there was no significant difference in vessel diameter for either the LAD or the LCX artery between the IVUS (group 3) and no IVUS (group 1) groups. Within each group, the lumen of both the LAD and LCX nar...

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