Hernandez Jose M de la Torre, de Prada Jose A Vazquez, Burgos Virginia, Sainz Laso Fermin, Valls Monica Fernandez, Vilchez Francisco Gonzalez, Llano Miguel, Ruano Javier, Zueco Javier, Colman Thierry, Duran Rafael Martín
Interventional Cardiology Department, Servicio de Cardiología, Hospital Universitario Marques de Valdecilla, Santander, Spain.
J Heart Lung Transplant. 2009 Feb;28(2):156-62. doi: 10.1016/j.healun.2008.11.915.
Cardiac allograft vasculopathy (CAV) is the main cause of graft loss and death in heart transplant (HTx) recipients surviving >1 year. There is a dual etiology for coronary disease in HTx: classic atherosclerosis and an immunologically mediated disease. Intravascular ultrasound (IVUS) is highly sensitive for CAV detection; however, gray-scale IVUS is of limited value for identification of specific plaque components. We sought to characterize graft coronary artery disease by means of IVUS-virtual histology (IVUS-VH) at different time-points of follow-up and to correlate plaque composition with clinical factors.
In our study we included 67 patients, who were 7.6 +/- 5.7 years post-HTx. IVUS gray-scale evaluation was performed on all patients. IVUS-VH analysis was done in those patients showing intimal thickening >0.5 mm at the three more significant lesions (three cross-sections for each) of the left anterior descending artery.
IVUS-VH analysis was obtained done on 58 patients (86.5%). We found a significant correlation between time of HTx and IVUS gray-scale parameters (plaque area and plaque burden), with both increasing over time. We also found a significant correlation between time and IVUS-VH-derived plaque components, necrotic core and calcium, which increased with time, and fibrous and fibrofatty components, both decreased at follow-up. IVUS-VH results were also related to donor age and cardiovascular risk factors.
We observed a time-related change in IVUS-VH-derived plaque composition. Necrotic core and calcium, typical atheromatous components, become more prevalent with time after HTx, especially when influenced by cardiovascular risk factors. The presence of a necrotic core in the early stages was linked to older donor age.
心脏移植血管病变（CAV）是心脏移植（HTx）术后存活超过1年患者移植物丢失和死亡的主要原因。HTx患者的冠心病有双重病因：经典动脉粥样硬化和免疫介导疾病。血管内超声（IVUS）对CAV检测高度敏感；然而，灰阶IVUS在识别特定斑块成分方面价值有限。我们试图通过IVUS虚拟组织学（IVUS-VH）在随访的不同时间点对移植冠状动脉疾病进行特征分析，并将斑块成分与临床因素相关联。
我们的研究纳入了67例患者，他们在HTx术后7.6±5.7年。对所有患者进行了IVUS灰阶评估。对左前降支三个更显著病变（每个病变三个横截面）内膜增厚>0.5mm的患者进行IVUS-VH分析。
对58例患者（86.5%）进行了IVUS-VH分析。我们发现HTx时间与IVUS灰阶参数（斑块面积和斑块负荷）之间存在显著相关性，两者均随时间增加。我们还发现时间与IVUS-VH衍生的斑块成分、坏死核心和钙之间存在显著相关性，坏死核心和钙随时间增加，而纤维和纤维脂肪成分在随访时均减少。IVUS-VH结果也与供体年龄和心血管危险因素有关。
我们观察到IVUS-VH衍生的斑块成分随时间变化。坏死核心和钙是典型的动脉粥样硬化成分，在HTx术后随时间变得更为普遍，尤其是受心血管危险因素影响时。早期坏死核心的存在与供体年龄较大有关。
