Kerber S, Rahmel A, Heinemann-Vechtel O, Budde T, Deng M, Scheld H H, Breithardt G
Department of Cardiology and Angiology, Hospital of the Westfälische Wilhelms-University of Münster, Germany.
Int J Cardiol. 1995 Apr;49(2):119-29. doi: 10.1016/0167-5273(95)02292-5.
Accelerated graft atherosclerosis is responsible for increased mortality and morbidity among heart transplant recipients. The aim of this in-vivo study was to evaluate coronary atherosclerotic vessel alterations and endothelial function. Seventeen patients (14 males; mean age 49.3 years; range 24 to 69) were studied an average of 11 weeks (range 5 to 21) after heart transplantation because of coronary artery disease (n = 8), dilative cardiomyopathy (n = 7), mitral valve replacement (n = 1) and left atrial metastases of a leiomyosarcoma (n = 1). Mean age of the donor hearts (9 males) was 29 years (range 12 to 55). All recipients underwent biplane ventriculography and coronary angiography. In this study population, a total of 120 coronary segments (main stem, 21; left anterior descending artery, 85; circumflex artery, 14) were analyzed by intravascular ultrasound (20 MHz, 3.5F). In 13 patients, acetylcholine was infused into the proximal left anterior descending artery (10(-8) to 10(-5) M) to evaluate vasomotion within this segment. Regional contraction abnormalities were documented in 2 patients. Nine segments angiographically showed non-critical stenoses (5 patients). Intravascular ultrasound detected 52 cross-sectional areas with a three-layer pattern indicating intimal thickening. Mean circumferential extension of intimal proliferation was 192 degrees, mean intimal thickness 0.35 mm. Only 5 segments of the sonographically pathological cross-sectional areas showed angiographical evidence of atherosclerotic lesions. Intracoronary administration of acetylcholine at doses of 10(-8) and 10(-7) M resulted in vasoconstriction of the examined coronary segment in only 2 patients; the intracoronary application of acetylcholine at doses of 10(-6) and 10(-5) M revealed coronary vasoconstriction in 10 of the total of 13 patients. Using intravascular ultrasound, coronary artery lesions in heart transplant recipients can already be depicted at a very early stage. The abnormal response to acetylcholine in most of the heart recipients is independent of the extent of atherosclerotic vessel abnormalities documented by ultrasound or angiography.
加速性移植血管动脉粥样硬化是导致心脏移植受者死亡率和发病率增加的原因。这项体内研究的目的是评估冠状动脉粥样硬化血管改变和内皮功能。17例患者（14例男性；平均年龄49.3岁；范围24至69岁）在心脏移植后平均11周（范围5至21周）接受研究，病因包括冠状动脉疾病（n = 8）、扩张型心肌病（n = 7）、二尖瓣置换术（n = 1）和平滑肌肉瘤左心房转移（n = 1）。供体心脏（9例男性）的平均年龄为29岁（范围12至55岁）。所有受者均接受了双平面心室造影和冠状动脉造影。在该研究人群中，共120个冠状动脉节段（主干21个；左前降支85个；回旋支14个）通过血管内超声（20MHz，3.5F）进行分析。13例患者中，向左前降支近端注入乙酰胆碱（10⁻⁸至10⁻⁵M）以评估该节段内的血管运动。2例患者记录到局部收缩异常。9个节段血管造影显示非临界狭窄（5例患者）。血管内超声检测到52个具有三层模式的横截面积，提示内膜增厚。内膜增殖的平均周向延伸为192度，平均内膜厚度为0.35mm。超声检查病理横截面积中只有5个节段显示有动脉粥样硬化病变的血管造影证据。冠状动脉内给予10⁻⁸和10⁻⁷M剂量的乙酰胆碱仅在2例患者中导致所检查冠状动脉节段的血管收缩；冠状动脉内给予10⁻⁶和10⁻⁵M剂量的乙酰胆碱在总共13例患者中的10例中显示冠状动脉收缩。使用血管内超声，心脏移植受者的冠状动脉病变在很早阶段就可以被描绘出来。大多数心脏受者对乙酰胆碱的异常反应与超声或血管造影记录的动脉粥样硬化血管异常程度无关。
