König Andreas, Kilian Eckehard, Rieber Johannes, Schiele Thomas M, Leibig Marcus, Sohn Hae-Young, Reichart Bruno, Klauss Volker
Department of Medicine, Division of Cardiology, Medizinische Klinik und Poliklinik-Innenstadt, Munich, Germany.
J Heart Lung Transplant. 2008 Jan;27(1):26-30. doi: 10.1016/j.healun.2007.10.005.
Cardiac allograft vasculopathy (CAV) is the major limitation in survival of patients after heart transplantation. Cardiac allograft vasculopathy is angiographically silent in the early phase after operation. Intravascular ultrasound (IVUS) is a more sensitive method to detect the early stages of CAV and provides information about its development. Recent IVUS studies demonstrated a rapid progression of CAV within the first year after transplantation as a predictor of morbidity and mortality.
This study assessed the plaque composition of early atherosclerosis in transplant patients by radiofrequency analysis.
Coronary angiography and IVUS with Virtual Histology (VH) software (Real-Time VH, Volcano Corp, Rancho Cordova, CA) were used to assess 18 patients early after heart transplantation (1.71 +/- 0.47 months). The plaque composition was determined by IVUS radiofrequency data analysis. Tissue maps were reconstructed from radiofrequency data using VH-IVUS software. The VH-IVUS acquisition was performed with standardized IVUS (EagleEye catheter; 2.9 F/20 MHz; Volcano Corp) and the VH-IVUS console (Volcano Corp).
Coronary angiography did not show any wall irregularities. Intravascular ultrasound demonstrated donor-transmitted atherosclerosis in 6 of 18 patients (33.33%). The incidence, amount of plaque burden, and plaque composition was significantly related to donor age. By VH-IVUS analysis, the plaque composition consisted mainly of fibrotic tissue.
Donor-transmitted coronary atherosclerosis is present early after heart transplantation and cannot be detected by coronary angiography. VH-IVUS gives detailed information about the plaque distribution and the plaque composition.
心脏移植术后患者生存的主要限制因素是心脏移植血管病变（CAV）。心脏移植血管病变在术后早期血管造影时无异常表现。血管内超声（IVUS）是检测CAV早期阶段更敏感的方法，并能提供其发展相关信息。近期IVUS研究表明，移植后第一年内CAV快速进展，可作为发病和死亡的预测指标。
本研究通过射频分析评估移植患者早期动脉粥样硬化的斑块成分。
采用冠状动脉造影和带有虚拟组织学（VH）软件（实时VH，Volcano公司，加利福尼亚州兰乔科尔多瓦）的IVUS对18例心脏移植术后早期患者（1.71±0.47个月）进行评估。通过IVUS射频数据分析确定斑块成分。使用VH-IVUS软件从射频数据重建组织图。VH-IVUS采集使用标准化IVUS（鹰眼导管；2.9F/20MHz；Volcano公司）和VH-IVUS控制台（Volcano公司）进行。
冠状动脉造影未显示任何管壁不规则。血管内超声显示18例患者中有6例（33.33%）存在供体传播的动脉粥样硬化。发病率、斑块负荷量和斑块成分与供体年龄显著相关。通过VH-IVUS分析，斑块成分主要由纤维组织组成。
心脏移植术后早期存在供体传播的冠状动脉粥样硬化，冠状动脉造影无法检测到。VH-IVUS可提供有关斑块分布和斑块成分的详细信息。
