Kerber S, Rahmel A, Karbenn U, Heinemann-Vechtel O, Fechtrup C, Lamp B, Block M, Budde T, Hoffmeier A, Weyand M
Medizinische Klinik und Poliklinik (Kardiologie/Angiologie), Institut für Arterioskleroseforschung, Bereich Koronare Herzerkrankung.
Z Kardiol. 1994 Mar;83(3):215-24.
Accelerated graft coronary atherosclerosis disease is the main reason for long-term mortality and morbidity of heart transplant recipients. The aim of this in vivo study was to evaluate coronary atherosclerotic vessel abnormalities and endothelial function using angiography, intravascular ultrasound, and intracoronary acetylcholine infusion. Fourteen patients (11 male, 3 female; mean age 49.3 years) were examined early after heart transplantation (mean interval after transplantation: 11 weeks) because of coronary artery disease (n = 8), idiopathic dilatative cardiomyopathy (n = 7), mitral valve replacement (n: 1) or left atrial filiae of a leiomyosarcoma (n = 1). Mean age of the donor hearts (female n = 8) was 29 years; 3 patients received double- and 14 patients triple-immunosuppression. All patients underwent biplane ventriculography and coronary angiography; a total of 120 coronary segments (main stem 21, left anterior descending artery 85, circumflex artery 14) was examined by intravascular ultrasound (20 MHz, 3.5 F catheters). In 13 patients, acetylcholine was infused into the proximal left anterior descending artery (0.15 microgram/min to 150.0 micrograms/min) to evaluate vasomotion within this segment. Ventriculography demonstrated regional wall abnormalities in 2 patients, angiography revealed 9 noncritical stenotic segments in 5 patients. Intravascular ultrasound detected 52 cross-sectional areas with a three-layer appearance indicating intimal thickening. Mean circumferential expansion of intimal proliferation was 192 degrees and mean intimal thickness was 0.35 mm. Only 5 segments of the sonographically pathological cross-sectional areas showed angiographic evidence of atherosclerotic lesions. After intracoronary infusion at a lower dose (0.15 and 1.5 micrograms/min) of acetylcholine, vasoconstriction was observed in 2 patients, at a dose of 15.0 and 150.0 micrograms/min in 10 patients. This response to acetylcholine did not depend on the intravascular or angiographical extent of atherosclerotic vessel abnormalities. In heart transplant recipients, coronary artery abnormalities can already be depicted at an early stage using intravascular ultrasound. The majority of patients show coronary vasoconstriction following infusion of acetylcholine at a higher dose. Further investigation is necessary to clarify whether the depicted vessel wall abnormalities can already be interpreted as newly developed graft atherosclerosis and whether abnormal vasomotion after acetylcholine is indicative of endothelial dysfunction.
加速性移植冠状动脉粥样硬化疾病是心脏移植受者长期死亡率和发病率的主要原因。本体内研究的目的是使用血管造影、血管内超声和冠状动脉内乙酰胆碱注入来评估冠状动脉粥样硬化血管异常和内皮功能。14例患者（11例男性，3例女性；平均年龄49.3岁）在心脏移植后早期（移植后平均间隔时间：11周）接受检查，病因包括冠状动脉疾病（n = 8）、特发性扩张型心肌病（n = 7）、二尖瓣置换术（n = 1）或平滑肌肉瘤左心房丝状物（n = 1）。供体心脏的平均年龄（女性n = 8）为29岁；3例患者接受双重免疫抑制，14例患者接受三重免疫抑制。所有患者均接受了双平面心室造影和冠状动脉造影；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（20 MHz，3.5 F导管）进行检查。在13例患者中，将乙酰胆碱注入左前降支近端（0.15微克/分钟至150.0微克/分钟）以评估该节段内的血管运动。心室造影显示2例患者有局部壁异常，血管造影显示5例患者有9个非临界狭窄节段。血管内超声检测到52个具有三层外观的横截面积，提示内膜增厚。内膜增殖的平均周向扩展为192度，平均内膜厚度为0.35毫米。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。冠状动脉内注入较低剂量（0.15和1.5微克/分钟）的乙酰胆碱后，2例患者出现血管收缩，注入剂量为15.0和150.0微克/分钟时，10例患者出现血管收缩。这种对乙酰胆碱的反应不取决于动脉粥样硬化血管异常的血管内或血管造影范围。在心脏移植受者中，使用血管内超声可以在早期描绘冠状动脉异常。大多数患者在注入较高剂量的乙酰胆碱后出现冠状动脉血管收缩。需要进一步研究以阐明所描绘的血管壁异常是否已可解释为新发生的移植冠状动脉粥样硬化，以及乙酰胆碱后异常的血管运动是否指示内皮功能障碍。
