Kerber S, Heinemann-Vechtel O, Günther F, Rahmel A, Weyand M, Deng M, Scheld H H, Breithardt G
Department of Cardiology/Angiology, Westfälische Wilhelms-Universität Münster, Germany.
Eur Heart J. 1996 Dec;17(12):1891-7. doi: 10.1093/oxfordjournals.eurheartj.a014808.
The aim of this study was to investigate coronary compliance in patients early and 71.8 weeks after orthotopic heart transplantation.
Thirty patients (mean age 51.4 years, women n = 6) underwent coronary angiography early after orthotopic heart transplantation (mean interval 11.6 +/- 5.5 weeks), by which time 12 recipients had already been treated for episodes of rejection. A total of 153 different coronary segments were investigated using a mechanical 30 MHz intravascular ultrasound system. In all segments, the intimal index and the circumferential extension of the vessel wall, which had a three-layered appearance, were assessed. Systolic-diastolic changes in area, and pressure with respect to vessel wall area, were used to study normalized compliance. All measurements were repeated in a subgroup of 13 patients 71.8 +/- 10.7 weeks after transplantation.
At the first investigation, the mean intimal index of all estimated cross-sectional areas was 0.07 +/- 0.10. The mean circumferential extension of the 'three-layered' coronary vessel wall was 74 degrees +/- 101 degrees. No correlation could be found between normalized compliance and the intimal index (r = -0.322, P < 0.001) or between normalized compliance and the circumferential extension of the three-layered vessel wall (r = -0.362, P < 0.001). Donor age did not correlate with normalized compliance either (r = -0.515, P = 0.004). In 12 patients with proven rejection periods before the first investigation, normalized compliance was significantly lower (1.76 +/- 0.81 mmHg-1) than in those without rejection (2.95 +/- 1.22 mmHg-1, P = 0.005). Both the intimal index and the circumferential extension of the three-layered architecture of the vessel wall were significantly higher in recipients with rejection periods. A comparison of the subgroup of 13 recipients between first and second investigation showed that the intimal index increased slightly from 0.03 +/- 0.03 to 0.09 +/- 0.13 (ns) 71.8 weeks after transplantation, but that normalized compliance did not differ significantly between the first and the follow-up investigation.
Early after orthotopic heart transplantation, normalized compliance does not correlate with donor age or the extent of atherosclerotic vessel alterations identifiable by intravascular ultrasound. Early rejection periods are associated with reduced coronary arterial compliance. Using intravascular ultrasound, this adverse functional effect on arterial compliance can be observed together with an increase in the intimal index.
本研究旨在调查原位心脏移植术后早期及术后71.8周患者的冠状动脉顺应性。
30例患者（平均年龄51.4岁，女性6例）在原位心脏移植术后早期（平均间隔11.6±5.5周）接受冠状动脉造影，此时12例受者已因排斥反应发作接受治疗。使用机械30MHz血管内超声系统对总共153个不同的冠状动脉节段进行研究。在所有节段中，评估了内膜指数以及具有三层外观的血管壁的圆周延伸。使用面积的收缩-舒张变化以及相对于血管壁面积的压力来研究标准化顺应性。在移植后71.8±10.7周，对13例患者的亚组重复进行所有测量。
在首次调查时，所有估计横截面积的平均内膜指数为0.07±0.10。“三层”冠状动脉血管壁的平均圆周延伸为74°±101°。标准化顺应性与内膜指数之间无相关性（r=-0.322，P<0.001），标准化顺应性与三层血管壁的圆周延伸之间也无相关性（r=-0.362，P<0.001）。供体年龄与标准化顺应性也无相关性（r=-0.515，P=0.004）。在首次调查前有明确排斥期的12例患者中，标准化顺应性显著低于无排斥反应的患者（1.76±0.81mmHg-1对2.95±1.22mmHg-1，P=0.005）。有排斥期的受者的内膜指数和血管壁三层结构的圆周延伸均显著更高。对13例受者在首次和第二次调查之间的亚组比较显示，移植后71.8周内膜指数从0.03±0.03略有增加至0.09±0.13（无统计学意义），但首次和随访调查之间标准化顺应性无显著差异。
原位心脏移植术后早期，标准化顺应性与供体年龄或血管内超声可识别的动脉粥样硬化血管改变程度无关。早期排斥期与冠状动脉顺应性降低有关。使用血管内超声，可以观察到对动脉顺应性的这种不良功能影响以及内膜指数的增加。
