Watanabe Takuya, Seguchi Osamu, Yanase Masanobu, Fujita Tomoyuki, Murata Yoshihiro, Sato Takuma, Sunami Haruki, Nakajima Seiko, Kataoka Yu, Nishimura Kunihiro, Hisamatsu Eriko, Kuroda Kensuke, Okada Norihiro, Hori Yumiko, Wada Kyoichi, Hata Hiroki, Ishibashi-Ueda Hatsue, Miyamoto Yoshihiro, Fukushima Norihide, Kobayashi Junjiro, Nakatani Takeshi
1 Department of Transplantation, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan. 2 Department of Preventive Cardiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan. 3 Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan. 4 Department of Cardiology, Kumiai Kosei Hospital, Takayama, Gifu, Japan. 5 Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan. 6 Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan. 7 Department of Nursing, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan. 8 Department of Pharmacy, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan. 9 Department of Pathology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
Transplantation. 2017 Jun;101(6):1310-1319. doi: 10.1097/TP.0000000000001322.
The influence of preexisting donor-transmitted atherosclerosis (DA) on cardiac allograft vasculopathy (CAV) development remains unclear.
We performed 3-dimensional intravascular ultrasound (3D-IVUS) analysis in 42 heart transplantation (HTx) recipients at 2.1 ± 0.9 months (baseline) and 12.2 ± 0.4 months post-HTx, as well as consecutive 3D-IVUS analyses up to 3 years post-HTx in 35 of the 42 recipients. Donor-transmitted atherosclerosis was defined as a maximal intimal thickness of 0.5 mm or greater at baseline. Changes in volumetric IVUS parameters were compared in recipients with (DA group) and without DA (DA-free group) at baseline, 1 year, and 3 years post-HTx.
Donor-transmitted atherosclerosis was observed in 57.1% of 42 recipients. The DA group exhibited a significantly greater increase in plaque volume at 1 year post-HTx (P < 0.001), leading to increased percent plaque volume (plaque volume/vessel volume, [%]) (P < 0.001) and decreased luminal volume (P = 0.021). Donor-transmitted atherosclerosis was independently associated with a greater increase in percent plaque volume during the first post-HTx year (P = 0.011). From 1 to 3 years post-HTx, the DA group underwent continuous reduction in luminal volume (P = 0.022). These changes resulted in a higher incidence of angiographic CAV at 3 years post-HTx in the DA group (58.8% vs 5.6%, P = 0.002).
This volumetric IVUS study suggests that DA correlates with the worsening change in CAV several years post-HTx. Donor-transmitted atherosclerosis recipients may require more aggressive treatment to prevent subsequent CAV progression.
预先存在的供体传播性动脉粥样硬化（DA）对心脏移植血管病变（CAV）发展的影响仍不清楚。
我们对42例心脏移植（HTx）受者在HTx后2.1±0.9个月（基线）和12.2±0.4个月进行了三维血管内超声（3D-IVUS）分析，并对42例受者中的35例在HTx后长达3年进行了连续的3D-IVUS分析。供体传播性动脉粥样硬化定义为基线时最大内膜厚度≥0.5mm。比较了HTx后基线、1年和3年时伴有DA（DA组）和不伴有DA（无DA组）的受者的血管内超声容积参数变化。
42例受者中57.1%观察到供体传播性动脉粥样硬化。DA组在HTx后1年时斑块体积显著增加（P<0.001），导致斑块体积百分比（斑块体积/血管体积，[%]）增加（P<0.001）和管腔体积减小（P=0.021）。供体传播性动脉粥样硬化与HTx后第一年斑块体积百分比的更大增加独立相关（P=0.011）。从HTx后1年到3年，DA组管腔体积持续减小（P=0.022）。这些变化导致DA组在HTx后3年时血管造影CAV的发生率更高（58.8%对5.6%，P=0.002）。
这项血管内超声容积研究表明，DA与HTx后数年CAV的恶化变化相关。供体传播性动脉粥样硬化的受者可能需要更积极的治疗以预防随后的CAV进展。
