Zakliczyński M, Konecka-Mrówka D, Lekston A, Nozyński J, Pyka L, Trybunia D, Swierad M, Zembala M
Department of Cardiac Surgery & Transplantation, Silesian Center for Heart Diseases, ul Szpitalna 2, 41-800 Zabrze, Poland.
Transplant Proc. 2009 Oct;41(8):3209-13. doi: 10.1016/j.transproceed.2009.09.032.
The aim of the study was to examine the potential relation between microvasculopathy observed in endomyocardial biopsies (EMBs) and clinical coronary vasculopathy (CAV) after orthotopic heart transplantation (OHT).
We preformed a retrospective analysis involving 68 OHT patients in whom the procedure was performed before 1999. The CAV(+) group consisted of 37 subjects (35 males/2 females) of overall mean age of 45 +/- 11 years. Ischemic cardiomyopathy was the diagnosis in 57% of the cohort that displayed CAV established by angioplasty, myocardial infarction, or CAV-related death. The control group contained 31 subjects (24 male/7 female) of overall mean age of 43 +/- 16 years. The pretransplant diagnosis was ischemic c-pathy in 39%. These subjects displayed negative coronary angiography at 10 years after OHT. Based upon studies early after OHT 55 subjects were divided based on the myocardial blush grade (MBG) upon coronary angiography performed between 4th and 6th week after surgery: one cohort of six individuals showed decreased MBG (6 males) of mean age 52 +/- 7 years. There was prior ischemic c-pathy in 50%. In contrast, 49 subjects showed a normal MBG (43 males/67 females) of overall mean age of 45 +/- 12 years. Ischemic c-pathy had been present in 39%. Microvasculopathy was defined as the presence of prominent endothelial cells, vacuolation of the endothelium, thickening of the basal membrane and/or muscle layer, the presence of lymphocytes in the arteriolar wall, periarteriolar fibrosis, or stenotic arteriolar lumenia in the 12- and 36 month EMB (CAV groups) or the 4-week EMB (MBG groups).
Rejection grades were comparable in CAV(+) and CAV(-) groups, but decreased in normal MBG group. The only significant difference was observed in the occurrence of basal membrane thickening, which was present in 22% of subjects from the CAV(+) group and 3% of individuals from the CAV(-) group in the 12-month EMB.
Microvasculopathy observed early or late after OHT was not related to angiographically confirmed CAV.
本研究的目的是检查原位心脏移植（OHT）后心内膜心肌活检（EMB）中观察到的微血管病变与临床冠状动脉病变（CAV）之间的潜在关系。
我们对1999年前接受该手术的68例OHT患者进行了回顾性分析。CAV（+）组由37名受试者组成（35名男性/2名女性），总体平均年龄为45±11岁。57%的队列诊断为缺血性心肌病，其CAV通过血管成形术、心肌梗死或CAV相关死亡确定。对照组包含31名受试者（24名男性/7名女性），总体平均年龄为43±16岁。移植前诊断为缺血性心肌病的占39%。这些受试者在OHT后10年冠状动脉造影显示为阴性。根据OHT术后早期的研究，55名受试者根据术后第4至6周进行的冠状动脉造影时的心肌 blush 分级（MBG）进行分组：一组6名个体（6名男性）MBG降低，平均年龄为（52±7）岁。50%有既往缺血性心肌病。相比之下，49名受试者MBG正常（43名男性/6名女性），总体平均年龄为45±12岁。39%有缺血性心肌病。微血管病变定义为在12个月和36个月的EMB（CAV组）或4周的EMB（MBG组）中存在突出内皮细胞、内皮细胞空泡化、基底膜和/或肌层增厚、小动脉壁淋巴细胞浸润及小动脉周围纤维化或小动脉管腔狭窄。
CAV（+）组和CAV（-）组的排斥反应分级相当，但正常MBG组降低。仅在基底膜增厚的发生率上观察到显著差异，在12个月的EMB中，CAV（+）组22%的受试者和CAV（-）组3%的个体存在基底膜增厚。
OHT术后早期或晚期观察到的微血管病变与血管造影证实的CAV无关。
