Lumen Loss in Transplant Coronary Artery Disease Is a Biphasic Process Involving Early Intimal Thickening and Late Constrictive Remodeling

Tsutsui, Hiroshi; Ziada, Khaled M.; Schoenhagen, Paul; İyisoy, Atila; Magyar, William A.; Crowe, Tim; Klingensmith, Jon D.; Vince, D. Geoffrey; Rincón, Gustavo; Hobbs, Robert E.; Yamagishi, Masakazu; Nissen, Steven E.; Tuzcu, E. Murat

doi:10.1161/hc3101.093867

Cited by 141 publications

(27 citation statements)

References 28 publications

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“…This is important because lumen loss in CAV is caused not only by intimal thickening but also by changes in external elastic membrane area. (16–18) We show that the addition of a liver graft attenuates plaque progression with no effect on vessel volume progression. This suggests that the mechanism of slower progression of CAV with H+Liver Tx involves a reduced rate of intimal hyperplasia and plaque progression with no effect on vessel remodeling, at least in the first two years after transplant.…”

Section: Discussionmentioning

confidence: 83%

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Combined Heart and Liver Transplant Attenuates Cardiac Allograft Vasculopathy Compared with Isolated Heart Transplantation

et al. 2013

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Background We evaluated whether combined heart liver transplant can protect the heart graft from the development of Cardiac allograft vasculopathy (CAV) using coronary 3D volumetric IVUS. Methods From 2004 to 2009, we identified 24 isolated heart transplant (HTx) and 10 combined heart liver transplant (H+Liver Tx) recipients in whom two coronary 3D IVUS studies were performed one year apart. Baseline 3D IVUS was performed at 0.22 [0.17, 1.16] years after transplant with follow up 3D IVUS exams performed 0.96 [0.83, 1.08] after baseline exam. Results Rate of plaque volume and plaque index (plaque volume/vessel volume) progression was attenuated in the H+Liver Tx group (0.3±1.1 mm3/mm vs. 1.5±2.9 mm3/mm; P=0.08, and 0.01±0.03 vs. 0.1±0.1; P=0.004 respectively). Rejection burden was much lower in the H+Liver Tx patients. Outcome analysis in 66 consecutive patients (56 HTx and 10 H+Liver Tx) was performed irrespective of performance of second coronary IVUS. Combined heart and liver transplant was associated with reduced rate of cardiac events (p=0.04), which remained significant when adjusted for the difference in the primary etiology for heart disease (p=0.05). Conclusions Our preliminary serial 3D coronary IVUS data show that combined heart and liver transplant attenuates CAV by decreasing the rate of plaque volume and plaque index progression and improves coronary related outcomes. Because of the small numbers and the differences in etiology of heart disease our data should be interpreted cautiously, and larger clinical trials would be required to recommend combined heart liver transplant for improved coronary remodeling.

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Section: Discussionmentioning

confidence: 83%

“…3D IVUS is presently considered the gold standard for the evaluation of CAV (14–16) and quantifies both intimal thickening and changes in external elastic membrane area (arterial remodeling). This is important because lumen loss in CAV is caused not only by intimal thickening but also by changes in external elastic membrane area.…”

Section: Discussionmentioning

confidence: 99%

Combined Heart and Liver Transplant Attenuates Cardiac Allograft Vasculopathy Compared with Isolated Heart Transplantation

et al. 2013

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“…In their serial 2D-IVUS study, Tsutsui et al 33 reported that early lumen loss on CAV was caused by intimal thickening, while late lumen loss was caused by vessel constriction. Our results showed that the mechanism for lumen loss in the DA group was consistent with that in Tsutsui et al's study.…”

Section: Discussionmentioning

confidence: 99%

Donor-Transmitted Atherosclerosis Associated With Worsening Cardiac Allograft Vasculopathy After Heart Transplantation

et al. 2017

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BackgroundThe influence of preexisting donor-transmitted atherosclerosis (DA) on cardiac allograft vasculopathy (CAV) development remains unclear.MethodsWe performed 3-dimensional intravascular ultrasound (3D-IVUS) analysis in 42 heart transplantation (HTx) recipients at 2.1 ± 0.9 months (baseline) and 12.2 ± 0.4 months post-HTx, as well as consecutive 3D-IVUS analyses up to 3 years post-HTx in 35 of the 42 recipients. Donor-transmitted atherosclerosis was defined as a maximal intimal thickness of 0.5 mm or greater at baseline. Changes in volumetric IVUS parameters were compared in recipients with (DA group) and without DA (DA-free group) at baseline, 1 year, and 3 years post-HTx.ResultsDonor-transmitted atherosclerosis was observed in 57.1% of 42 recipients. The DA group exhibited a significantly greater increase in plaque volume at 1 year post-HTx (P < 0.001), leading to increased percent plaque volume (plaque volume/vessel volume, [%]) (P < 0.001) and decreased luminal volume (P = 0.021). Donor-transmitted atherosclerosis was independently associated with a greater increase in percent plaque volume during the first post-HTx year (P = 0.011). From 1 to 3 years post-HTx, the DA group underwent continuous reduction in luminal volume (P = 0.022). These changes resulted in a higher incidence of angiographic CAV at 3 years post-HTx in the DA group (58.8% vs 5.6%, P = 0.002).ConclusionsThis volumetric IVUS study suggests that DA correlates with the worsening change in CAV several years post-HTx. Donor-transmitted atherosclerosis recipients may require more aggressive treatment to prevent subsequent CAV progression.

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“…Elevated BNP has also been correlated with the development of CAV (Mehra et al, 2004b). BNP may be useful in combination with angiographic findings in predicting outcomes, with 50% of patients with high BNP levels and angiographic CAV experiencing cardiac death (Tsutsui et al, 2001). Biomarkers may hold predictive correlation, but are not used routinely for the evaluation of CAV.…”

Section: Ivus Parameters Include Intimal Thickness Intimal Index Anmentioning

confidence: 99%

Cardiac Allograft Vasculopathy: An Ongoing Challenge in the Care of Heart Transplant Recipients

Clarke¹,

Khush²

2012

Cardiac Transplantation

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Lumen Loss in Transplant Coronary Artery Disease Is a Biphasic Process Involving Early Intimal Thickening and Late Constrictive Remodeling

Cited by 141 publications

References 28 publications

Combined Heart and Liver Transplant Attenuates Cardiac Allograft Vasculopathy Compared with Isolated Heart Transplantation

Combined Heart and Liver Transplant Attenuates Cardiac Allograft Vasculopathy Compared with Isolated Heart Transplantation

Donor-Transmitted Atherosclerosis Associated With Worsening Cardiac Allograft Vasculopathy After Heart Transplantation

Cardiac Allograft Vasculopathy: An Ongoing Challenge in the Care of Heart Transplant Recipients

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