Ichibori Yasuhiro, Ohtani Tomohito, Nakatani Daisaku, Tachibana Kouichi, Yamaguchi Osamu, Toda Koichi, Akasaka Takashi, Fukushima Norihide, Sawa Yoshiki, Komuro Issei, Kotani Jun-ichi, Sakata Yasushi
Cardiovascular Medicine, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka 565-0871, Japan.
Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
Eur Heart J Cardiovasc Imaging. 2016 Jan;17(1):51-8. doi: 10.1093/ehjci/jev110. Epub 2015 May 14.
Neovascularization is closely associated with plaque progression in non-heart transplantation subjects; on the other hand, cardiac allograft vasculopathy causes unfavourable outcomes. Intravascular ultrasound (IVUS) and optical coherence tomography (OCT) can provide microscopic assessment in vivo. The aim of this study was to investigate the impact of neovascularization on intimal proliferation.
Both IVUS and OCT were attempted in 45 consecutive patients during annual catheterization after heart transplantation. There were 115 vessels [28 vessels were catheterized within 8 weeks of heart transplantation (baseline)]. IVUS analysis assessed vessel, luminal, and intimal (vessel-lumen) volume using Simpson's method. Qualitative parameters including microchannel were assessed by OCT. A microchannel was defined as a no-signal tubuloluminal structure with a sharply delineated border considered to represent neovascularization. Microchannel was observed more often in patient who had their heart transplant more than a year prior to the imaging, compared with shorter periods (39.1 vs. 10.7%, P = 0.023). All microchannels were seen in thickness >0.5 mm, and intimal volume index (mm(3)/mm) correlated with frequency of microchannel (r = 0.54, P = 0.04). The risks for microchannels were donor age [odds ratio (OR) 1.11; 95% confidence interval (CI) 1.03-1.22; P = 0.007], cytomegalovirus infection (OR 16.21; 95% CI 1.79-220.09; P = 0.012), diabetes (OR 9.5; 95% CI 1.21-116.10; P = 0.032), LDL-cholesterol (OR 1.07; 95% CI 1.01-1.13; P = 0.010), and intimal volume (OR 2.47; 95% CI 1.13-6.36; P = 0.023).
OCT-identified microchannels increased sharply within the first year and were correlated with intimal volume and coronary risks. This suggests that neovascularization may play an important role in the progression of cardiac allograft vasculopathy.
在非心脏移植受者中，新生血管形成与斑块进展密切相关；另一方面，心脏移植血管病变会导致不良后果。血管内超声（IVUS）和光学相干断层扫描（OCT）可在体内提供微观评估。本研究的目的是探讨新生血管形成对内膜增生的影响。
在心脏移植后的年度导管插入术中，对45例连续患者尝试进行IVUS和OCT检查。共有115条血管[28条血管在心脏移植后8周内（基线）进行了导管插入术]。IVUS分析采用辛普森法评估血管、管腔和内膜（血管-管腔）容积。通过OCT评估包括微通道在内的定性参数。微通道定义为边界清晰的无信号管腔结构，被认为代表新生血管形成。与较短时间相比，在成像前心脏移植超过一年的患者中更常观察到微通道（39.1%对10.7%，P = 0.023）。所有微通道均见于厚度>0.5 mm处，内膜容积指数（mm³/mm）与微通道频率相关（r = 0.54，P = 0.04）。微通道的风险因素包括供体年龄[比值比（OR）1.11；95%置信区间（CI）1.03 - 1.22；P = 0.007]、巨细胞病毒感染（OR 16.21；95% CI 1.79 - 220.09；P = 0.012）、糖尿病（OR 9.5；95% CI 1.21 - 116.10；P = 0.032）、低密度脂蛋白胆固醇（OR 1.07；95% CI 1.01 - 1.13；P = 0.010）和内膜容积（OR 2.47；95% CI 1.13 - 6.36；P = 0.023）。
OCT识别出的微通道在第一年急剧增加，且与内膜容积和冠状动脉风险相关。这表明新生血管形成可能在心脏移植血管病变的进展中起重要作用。
