Ramasubbu Kumudha, Schoenhagen Paul, Balghith Mohammed A, Brechtken Johannes, Ziada Khaled M, Kapadia Samir R, Hobbs Robert E, Rincon Gustavo, Nissen Steven E, Tuzcu E Murat
Department of Cardiology, The Cleveland Clinic Foundation, F25, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
J Am Coll Cardiol. 2003 May 21;41(10):1739-43. doi: 10.1016/s0735-1097(03)00339-5.
This study was designed to examine the impact of repeated intravascular ultrasound (IVUS) examinations on transplant coronary artery disease (CAD).
Serial IVUS is the most accurate method for early detection and surveillance of transplant CAD. However, the long-term safety of serial IVUS exams is not well described. Accordingly, we examined the impact of repeated IVUS examinations on transplant CAD.
We examined 226 transplant recipients who underwent one or more IVUS examinations and coronary angiography at least one year after the last IVUS exam. The coronary angiograms were analyzed using quantitative coronary angiography. Vessel diameters, frequency, and severity of stenoses in IVUS-imaged and nonimaged coronary arteries were compared. In a subgroup analysis of 31 patients, angiographic lumen diameters were measured at baseline (within eight weeks of transplantation) and during follow-up (after two, three, or four IVUS studies).
In the 226 patients, 548 coronary arteries were previously imaged by IVUS and 130 arteries were not imaged by IVUS. On subsequent angiograms, stenoses were observed in 16.2% (21/130) of nonimaged arteries and 19.5% (107/548) of imaged arteries (p = 0.38). The arterial diameters of nonimaged and imaged arteries were not significantly different (p = 0.07), regardless of the number of IVUS exams and duration of follow-up. Subgroup analysis revealed a significant decrease in vessel lumen diameter over time in nonimaged as well as imaged arteries. The magnitude of the diameter decrease was not significantly different between the two groups.
Repeated IVUS examinations following heart transplantation do not result in angiographically evident acceleration of transplant CAD. Therefore, serial IVUS imaging is a safe method for the detection and surveillance of transplant CAD.
本研究旨在探讨重复血管内超声（IVUS）检查对移植冠状动脉疾病（CAD）的影响。
连续IVUS是早期检测和监测移植CAD最准确的方法。然而，连续IVUS检查的长期安全性尚未得到充分描述。因此，我们研究了重复IVUS检查对移植CAD的影响。
我们检查了226名移植受者，他们在最后一次IVUS检查后至少一年接受了一次或多次IVUS检查和冠状动脉造影。使用定量冠状动脉造影分析冠状动脉造影。比较IVUS成像和未成像冠状动脉的血管直径、狭窄频率和严重程度。在31例患者的亚组分析中，在基线（移植后八周内）和随访期间（在进行两次、三次或四次IVUS研究后）测量血管造影管腔直径。
在226例患者中，548条冠状动脉先前通过IVUS成像，130条动脉未通过IVUS成像。在随后的血管造影中，未成像动脉中有16.2%（21/130）出现狭窄，成像动脉中有19.5%（107/548）出现狭窄（p = 0.38）。无论IVUS检查次数和随访时间长短，未成像和成像动脉的动脉直径均无显著差异（p = 0.07）。亚组分析显示，未成像和成像动脉的管腔直径随时间均显著减小。两组间直径减小幅度无显著差异。
心脏移植后重复IVUS检查不会导致移植CAD在血管造影上明显加速。因此，连续IVUS成像是检测和监测移植CAD的安全方法。
