Calé Rita, Almeida Manuel, Rebocho Maria José, Aguiar Carlos, Sousa Pedro, Brito João, Varandas Eduardo, Figueiredo Henrique, Gonçalves Pedro, Raposo Luís, Teles Rui, Machado Francisco, Queirós e Melo João, Silva José Aniceto
Departamento de Cardiologia e Cirurgia Cárdio-Torácica, Hospital Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide, Portugal.
Rev Port Cardiol. 2010 Feb;29(2):231-41.
Cardiac allograft vasculopathy is the main cause of morbidity and mortality after cardiac transplantation. Intravascular ultrasound (IVUS) is a sensitive imaging technique that provides detailed quantification of coronary atherosclerosis burden and could be a complement to routine angiography.
To determine the value of IVUS for detecting silent atherosclerotic disease in cardiac allograft recipients.
The study cohort consisted of 40 consecutive patients (mean age 55 +/- 11 years, 25% female) who underwent left anterior descending coronary artery IVUS (Volcano Therapeutics, Inc.) examination after transplantation. None of the patients had suspected or documented ischemia. Cardiac transplantation was due to ischemic cardiomyopathy in 30% (12 patients). Coronary artery disease (CAD) was defined as the presence of > or = 30% stenosis of vessel diameter (QCA analysis - Siemens CASS) on angiography and atherosclerotic lesions causing > or = 30% stenosis of vessel area by IVUS. The angiographic definition of significant CAD lesions was > or = 50% stenosis of vessel diameter, and by IVUS a minimum cross-sectional area of < or = 4 mm2.
CAD was identified in 20% (8 patients) by angiography and in 55% (22 patients) by IVUS (p = 0.003). Significant CAD was detected in 15% (6 patients) by angiography and in 7.5% (3 patients) by IVUS (p = 0.3).
The use of IVUS on routine screening coronary angiography detects a higher prevalence of early atherosclerotic disease than normal angiography, which should lead to implementation of preventive strategies to control disease progression. IVUS was no more sensitive than angiography in detecting severe coronary stenosis. IVUS should be used as a standard imaging technique together with routine coronary angiography to assess atherosclerosis burden in cardiac allograft recipients.
心脏移植血管病变是心脏移植后发病和死亡的主要原因。血管内超声（IVUS）是一种敏感的成像技术，可对冠状动脉粥样硬化负担进行详细量化，并且可以作为常规血管造影的补充。
确定IVUS在检测心脏移植受者无症状性动脉粥样硬化疾病中的价值。
研究队列包括40例连续患者（平均年龄55±11岁，25%为女性），这些患者在移植后接受了左前降支冠状动脉IVUS（Volcano Therapeutics公司）检查。所有患者均无疑似或记录在案的缺血情况。30%（12例）患者因缺血性心肌病接受心脏移植。冠状动脉疾病（CAD）定义为血管造影显示血管直径狭窄≥30%（QCA分析 - 西门子CASS），且IVUS显示动脉粥样硬化病变导致血管面积狭窄≥30%。血管造影对显著CAD病变的定义为血管直径狭窄≥50%，而IVUS为最小横截面积≤4mm²。
血管造影显示CAD的患者为20%（8例），IVUS显示为55%（22例）（p = 0.003）。血管造影检测到显著CAD的患者为15%（6例），IVUS为7.5%（3例）（p = 0.3）。
在常规筛查冠状动脉造影中使用IVUS检测到的早期动脉粥样硬化疾病患病率高于普通血管造影，这应促使实施预防策略以控制疾病进展。IVUS在检测严重冠状动脉狭窄方面并不比血管造影更敏感。IVUS应与常规冠状动脉造影一起作为标准成像技术，用于评估心脏移植受者的动脉粥样硬化负担。
