Dilated angiopathy: a specific subtype of allograft coronary artery disease.

Dilated coronary angiopathy exceeding the diameter of adjacent vessel segments by at least 50% was found in five of 68 heart transplant recipients undergoing coronary angiography greater than or equal to 1 year after heart transplantation. Severely delayed washout of the contrast medium from the dilated segments indicated local stasis. Dilated angiopathy was not combined with tubular narrowing of distal vessel segments or with focal eccentric lesions of the same artery. On the average, hemodynamic data were normal except in one patient. Signs of myocardial ischemia were not present on ECG and treadmill exercise testing. Age of the donor heart, ischemia time of the graft, prevalence of myocardial rejection episodes, cyclosporine dosage, and cholesterol serum levels did not differ from the whole group. We conclude that dilated angiopathy of the allograft is a specific subtype of the immune-mediated chronic vascular injury after heart transplantation that has not been described. The pathogenetic mechanisms for these findings are unknown. Although prognosis seems to be better in comparison with the other subtypes of allograft coronary artery disease, the patients may be at risk of embolic myocardial ischemia with progression of the disease.