Heroux A L, Silverman P, Costanzo M R, O'Sullivan E J, Johnson M R, Liao Y, McKiernan T L, Balhan J E, Leya F S, Mullen G M
Department of Medicine, Loyola University of Chicago, Maywood, Ill. 60153.
Circulation. 1994 Jan;89(1):272-7. doi: 10.1161/01.cir.89.1.272.
The diffuse nature of cardiac allograft vasculopathy makes early detection of the disease by traditional noninvasive methods or coronary angiography difficult. The aim of this study was to determine if there is a relation between abnormalities in vessel wall morphology, as assessed by intracoronary ultrasound, and a decreased vasodilatory response to the endothelium-dependent vasodilator papaverine hydrochloride and if cardiac allograft vasculopathy detected by coronary angiography is associated with specific intracoronary ultrasound findings.
Twenty-three heart transplant recipients underwent 25 intracoronary ultrasound studies and 24 studies of coronary vasomotor tone 10 days to 8.3 years after surgery using a 20-mHz intracoronary ultrasound catheter. The studies were divided in two groups according to the presence (n = 7, group 1) or absence (n = 18, group 2) of angiographically evident cardiac allograft vasculopathy. Qualitative assessment of vessel wall morphology and quantitative analysis of the vasodilator response to the injection of papaverine hydrochloride into the coronary artery distal to the imaging site were performed off-line, and results for the two study groups were compared. A significantly higher percentage of patients with than without angiographic evidence of cardiac allograft vasculopathy had a three-interface vessel wall morphology by intracoronary ultrasound (100% versus 11%, P < .001). In two recipients who underwent two serial studies, the appearance of three interfaces in the vessel wall or a progressive thickening of the inner interface of the vessel wall occurred in conjunction with the appearance of angiographic cardiac allograft vasculopathy. The vasodilator response to papaverine was less in patients with than in those without angiographically evident cardiac allograft vasculopathy both in terms of absolute and relative increases in lumen diameter (+0.1 +/- 0.12 mm versus +0.3 +/- 0.17 mm, P < .05, and +5.1 +/- 5.3% versus +8.2 +/- 5.3%, P = NS) and lumen cross-sectional area (+0.5 +/- 0.6 mm2 versus +1.7 +/- 1.1 mm2, P < .02, and +7.1 +/- 8.8% versus 16.6 +/- 11.0%, P = .055), respectively.
Intracoronary ultrasound assessment of vessel wall morphology and evaluation of vascular response to endothelium-dependent vasodilators are useful techniques for detecting cardiac allograft vasculopathy.
心脏移植血管病变具有弥漫性，使得通过传统非侵入性方法或冠状动脉造影早期检测该病较为困难。本研究的目的是确定通过冠状动脉内超声评估的血管壁形态异常与对内皮依赖性血管扩张剂盐酸罂粟碱的血管舒张反应降低之间是否存在关联，以及冠状动脉造影检测到的心脏移植血管病变是否与特定的冠状动脉内超声表现相关。
23名心脏移植受者在术后10天至8.3年使用20兆赫冠状动脉内超声导管接受了25次冠状动脉内超声检查和24次冠状动脉血管运动张力研究。根据冠状动脉造影显示的心脏移植血管病变情况（n = 7，第1组）或无病变情况（n = 18，第2组）将研究分为两组。对血管壁形态进行定性评估，并对在成像部位远端的冠状动脉内注射盐酸罂粟碱后的血管舒张反应进行定量分析，这些分析均离线进行，并比较两组研究结果。冠状动脉造影有心脏移植血管病变证据的患者中，通过冠状动脉内超声显示具有三相界面血管壁形态的患者比例显著高于无病变证据的患者（100%对11%，P <.001）。在两名接受了两次连续研究的受者中，血管壁三相界面的出现或血管壁内界面的逐渐增厚与冠状动脉造影显示的心脏移植血管病变的出现同时发生。无论从管腔直径的绝对增加还是相对增加来看（+0.1±0.12毫米对+0.3±0.17毫米，P <.05，以及+5.1±5.3%对+8.2±5.3%，P =无显著性差异），还是从管腔横截面积来看（+0.5±0.6平方毫米对+1.7±1.1平方毫米，P <.02，以及+7.1±8.8%对16.6±11.0%，P =.055），冠状动脉造影有心脏移植血管病变证据的患者对罂粟碱的血管舒张反应均低于无病变证据的患者。
冠状动脉内超声评估血管壁形态以及评估血管对内皮依赖性血管扩张剂的反应是检测心脏移植血管病变的有用技术。
