Torres H J, Merello L, Ramos S A, Aninat M A, Becerra L E, Mora A D, Valenzuela P T, Godoy M J, Prieto A A
Gustavo Fricke Hospital, Viña del Mar, Chile.
Transplant Proc. 2011 Jul-Aug;43(6):2318-21. doi: 10.1016/j.transproceed.2011.06.002.
Cardiac allograft vasculopathy (CAV) is a major factor limiting long-term survival after heart transplantation (HT). The purpose of this study was to characterize the coronary artery structure and to determine the prevalence of vasculopathy after HT, comparing the sensitivity of coronary angiography with that of intravascular ultrasound (IVUS) and virtual histology (VH).
A prospective recruitment cross-sectional study was performed in 31 adult HT recipients including 22 men and, 9 women of overall mean age of 45.2 ± 12.6 years at an average of 3.7 ± 3.7 years after transplantation. They underwent simultaneously coronary angiography and IVUS assessment of the left anterior descending coronary artery. We investigated histological composition of the intima. Final data were analyzed using parametric and nonparametric tests.
IVUS discovered the presence of CAV among 17/31 (54.8%) patients versus coronary angiography in 10 (32.3%; P = .009). The histological composition of the intima as assessed with IVUS VH was 26.1% fiber, 8.7% necrotic core, 5.7% calcium, and 4.3% lipid. There was no significant association between preexistent risk factors and the presence of CAV. There was a correlation between time elapsed since HT and CAV development.
Time elapsed since HT is the most important risk factor for the development of CAV. Its prevalence almost doubled when measured with IVUS in contrast with angiography. IVUS was thus shown to be a more sensitive diagnostic tool compared with coronary angiography.
心脏移植血管病变（CAV）是限制心脏移植（HT）后长期生存的主要因素。本研究的目的是描述冠状动脉结构，并确定HT后血管病变的患病率，比较冠状动脉造影与血管内超声（IVUS）及虚拟组织学（VH）的敏感性。
对31例成年HT受者进行前瞻性招募横断面研究，其中包括22名男性和9名女性，总体平均年龄为45.2±12.6岁，移植后平均时间为3.7±3.7年。他们同时接受了冠状动脉造影和左前降支冠状动脉的IVUS评估。我们研究了内膜的组织学组成。最终数据采用参数检验和非参数检验进行分析。
IVUS发现17/31（54.8%）的患者存在CAV，而冠状动脉造影发现10例（32.3%；P = 0.009）。用IVUS VH评估的内膜组织学组成是纤维占26.1%、坏死核心占8.7%、钙占5.7%、脂质占4.3%。既往危险因素与CAV的存在之间无显著关联。HT后经过的时间与CAV的发生之间存在相关性。
HT后经过的时间是CAV发生的最重要危险因素。与血管造影相比，用IVUS测量时其患病率几乎翻倍。因此，与冠状动脉造影相比，IVUS被证明是一种更敏感的诊断工具。
