Department of Cardiology, University Hospital Bern, CH-3010, Bern, Switzerland.
Heart. 2011 Apr;97(7):557-63. doi: 10.1136/hrt.2010.215137. Epub 2011 Jan 26.
The function of the coronary collateral circulation in heart transplant patients has not been investigated in a controlled fashion. Since it partly belongs to the microcirculation, which is affected by transplant vasculopathy, the hypothesis was tested that the coronary collateral circulation in heart transplant recipients is less developed than in coronary artery disease (CAD) patients.
40 heart transplant patients underwent a total of 51 quantitative, coronary pressure-derived collateral measurements and intravascular ultrasound (IVUS). The collateral flow index (CFI) was calculated as mean coronary occlusive pressure divided by mean aortic pressure, both subtracted by central venous pressure. A propensity score matching for angiographic coronary stenosis severity, heart rate, the presence of arterial hypertension and dyslipidaemia was performed using CAD patients of the institutional CFI database (n = 1076) as the control group.
Eighty per cent (32/40) of the heart transplant patients showed transplant vasculopathy as assessed by IVUS (intima thickness ≥ 0.5 mm). Without propensity score matching, CFI was equal to 0.152 ± 0.102 in the heart transplant group (age 55 ± 14 years) and 0.189 ± 0.134 in the entire CAD group (p = 0.054). After matching, CFI was 0.152 ± 0.102 in the heart transplant group and 0.176 ± 0.096 (p = 0.37) in the matched CAD group (age 63 ± 10 years). IVUS data were unrelated to CFI in the heart transplant group.
Heart transplant patients present with the same degree of functional collateral flow compared with a matched group of CAD patients.
心脏移植患者的冠状动脉侧支循环功能尚未得到对照研究。由于它部分属于受移植血管病影响的微循环，因此假设心脏移植受者的冠状动脉侧支循环不如冠心病（CAD）患者发达。
40 例心脏移植患者共进行了 51 次定量、冠状动脉压力衍生的侧支测量和血管内超声（IVUS）检查。侧支血流指数（CFI）计算为平均冠状动脉闭塞压除以平均主动脉压，两者均减去中心静脉压。使用机构 CFI 数据库中的 CAD 患者（n=1076）作为对照组，进行血管造影冠状动脉狭窄严重程度、心率、动脉高血压和血脂异常存在的倾向评分匹配。
80%（32/40）的心脏移植患者经 IVUS 评估存在移植血管病（内膜厚度≥0.5mm）。未经倾向评分匹配，心脏移植组 CFI 为 0.152±0.102（年龄 55±14 岁），整个 CAD 组为 0.189±0.134（p=0.054）。匹配后，心脏移植组 CFI 为 0.152±0.102，匹配的 CAD 组为 0.176±0.096（p=0.37）（年龄 63±10 岁）。心脏移植组的 IVUS 数据与 CFI 无关。
与匹配的 CAD 患者组相比，心脏移植患者具有相同程度的功能性侧支血流。
