Mehra M R, Ventura H O, Stapleton D D, Smart F W, Collins T C, Ramee S R
Department of Internal Medicine, Ochsner Medical Institutions, New Orleans, La 70121, USA.
J Heart Lung Transplant. 1995 Jul-Aug;14(4):632-9.
The clinical utility of intimal hyperplasia detected by intravascular ultrasonography in predicting cardiac events in heart transplant recipients with cardiac allograft vasculopathy has not been previously investigated.
Intravascular ultrasonographic examination of 74 consecutive heart transplant recipients, including 62 men and 12 women with a mean age of 51 +/- 10 years (range 22 to 68 years), was performed at the time of annual angiography. Two groups of study patients were identified: group I consisted of patients with minimal, mild, or moderate intimal thickness by intravascular ultrasonography, whereas group II patients had severe intimal thickness.
Patient characteristics were similar in both groups except for higher serum triglycerides (220 +/- 95 versus 165 +/- 79 mg/dl), more advanced donor age (28 +/- 11 versus 23 +/- 6 years) and greater duration of follow-up after transplantation (3.3 +/- 1.4 versus 1.8 +/- 1.2 years) in group II patients with severe intimal thickening (p < 0.01). Cardiac events were defined as the occurrence of sudden death, myocardial infarction, or the need for coronary revascularization via percutaneous or surgical intervention. One cardiac event occurred in group I patients (sudden death), whereas seven events were noted in the group II patients (p = 0.006). Cardiac events in the group of patients with severe intimal thickening included four patients with sudden cardiac death and three patients who underwent percutaneous revascularization procedures involving directional coronary atherectomy. Angiograms were normal in 62% of patients who had cardiac events.
This study represents one of the first reports that provides evidence that severe intimal hyperplasia predicts the development of cardiac events even in the presence of a normal coronary angiogram.
血管内超声检测到的内膜增生在预测心脏移植受者发生心脏移植血管病变时心脏事件方面的临床实用性此前尚未得到研究。
对74例连续的心脏移植受者进行血管内超声检查，其中包括62名男性和12名女性，平均年龄为51±10岁（范围22至68岁），检查在每年进行血管造影时进行。确定了两组研究患者：第一组由血管内超声显示内膜厚度最小、轻度或中度的患者组成，而第二组患者的内膜厚度严重。
两组患者的特征相似，但严重内膜增厚的第二组患者的血清甘油三酯水平较高（220±95对165±79mg/dl）、供体年龄更大（28±11对23±6岁）以及移植后随访时间更长（3.3±1.4对1.8±1.2年）（p<0.01）。心脏事件定义为猝死、心肌梗死的发生，或需要通过经皮或手术干预进行冠状动脉血运重建。第一组患者发生了1次心脏事件（猝死），而第二组患者记录到7次事件（p = 0.006）。内膜增厚严重的患者组中的心脏事件包括4例心源性猝死患者和3例接受了包括定向冠状动脉斑块旋切术在内的经皮血运重建手术的患者。发生心脏事件的患者中62%的血管造影正常。
本研究是首批提供证据表明即使在冠状动脉造影正常的情况下，严重内膜增生也可预测心脏事件发生的报告之一。
