光学相干断层扫描评估移植冠状动脉血管病与细胞排斥的相关性。
Optical coherence tomographic evaluation of transplant coronary artery vasculopathy with correlation to cellular rejection.
机构信息
From the NewYork Presbyterian Hospital, Columbia University Medical Center, New York, NY (L.D., A.M., T.M.N., A.T.P., S.S., L.E.R., M.A.A., K.D., J.W.M., U.P.J., D.M.M., G.W.); the Cardiovascular Research Foundation, New York, NY (L.D., A.M., S.S., J.W.M., K.X., G.S.M., G.W.); The Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang, China (L.D.); and Shaare Zedek Medical Center, Jerusalem, Israel (G.W.).
出版信息
Circ Cardiovasc Interv. 2014 Apr;7(2):199-206. doi: 10.1161/CIRCINTERVENTIONS.113.000949. Epub 2014 Apr 8.
BACKGROUND
Cardiac allograft vasculopathy is an accelerated fibroproliferative process that affects the coronary arteries of transplanted hearts. Intracoronary imaging with optical coherence tomography enables detection of subangiographic cardiac allograft vasculopathy.
METHODS AND RESULTS
At the time of routine surveillance coronary angiography, 48 consecutive heart transplant recipients underwent optical coherence tomographic imaging of 1 coronary artery. Imaging findings were compared per rejection history that was graded according to the International Society of Heart and Lung Transplantation classification as none/mild (International Society of Heart and Lung Transplantation 0, 1A/1B, or 2) or high-grade rejection (≥3A). Compared with the none/mild rejection group (37 patients) using Mann-Whitney U test, patients in the high-grade rejection group (11 patients) had a thicker intima in all coronary segments (distal: 0.22 mm [0.09-0.41] versus 0.09 mm [0.06-0.17], P=0.02; middle: 0.35 mm [0.00-0.45] versus 0.14 mm [0.08-0.24], P=0.002; and proximal: 0.34 mm [0.21-0.44] versus 0.15 mm [0.11-0.21], P=0.005) and a higher prevalence of foamy macrophages (distal: 55% versus 9%, P=0.003; middle: 55% versus 22%, P=0.004; and proximal: 44% versus 13%, P=0.05) using χ(2) statistics. Side branches in the high-grade rejection group had smaller lumen diameters and a higher prevalence of intimal thickening (54% versus 36%; P=0.01). Intimal microvessels were also more prevalent in the high-grade rejection group versus the none/mild rejection group (46% versus 11%; P=0.02).
CONCLUSIONS
Coronary optical coherence tomographic evaluation revealed that patients with a history of high-grade cellular rejection, compared with those with none/mild rejection, had more coronary artery intimal thickening with macrophage infiltration, involving all coronary segments and side branches.
CLINICAL TRIAL REGISTRATION URL
http://www.clinicaltrials.gov. Unique identifier: NCT01403142.
背景
心脏移植后发生的冠状动脉血管病是一种加速的纤维增生过程，可影响移植心脏的冠状动脉。光学相干断层扫描可用于检测冠状动脉内的心脏移植物血管病。
方法和结果
在常规监测冠状动脉造影时，对 48 例连续心脏移植受者的 1 支冠状动脉进行光学相干断层成像。根据国际心肺移植协会的分类，根据排斥反应病史将成像结果进行比较，分为无/轻度排斥反应（国际心肺移植协会 0、1A/1B 或 2）或高级别排斥反应（≥3A）。与无/轻度排斥反应组（37 例）相比，高级别排斥反应组（11 例）的所有冠状动脉节段的内膜均较厚（远端：0.22mm[0.09-0.41]比 0.09mm[0.06-0.17]，P=0.02；中段：0.35mm[0.00-0.45]比 0.14mm[0.08-0.24]，P=0.002；近端：0.34mm[0.21-0.44]比 0.15mm[0.11-0.21]，P=0.005），泡沫状巨噬细胞的发生率更高（远端：55%比 9%，P=0.003；中段：55%比 22%，P=0.004；近端：44%比 13%，P=0.05）。高级别排斥反应组的侧支血管的管腔直径较小，内膜增厚的发生率较高（54%比 36%，P=0.01）。与无/轻度排斥反应组相比，高级别排斥反应组的内膜微血管也更为常见（46%比 11%，P=0.02）。
结论
与无/轻度排斥反应患者相比，有高级别细胞排斥反应病史的患者，所有冠状动脉节段和侧支均有更明显的冠状动脉内膜增厚和巨噬细胞浸润。
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