BACKGROUND: This study investigated the relationship between periarterial neovascularization, development of cardiac allograft vasculopathy (CAV), and long-term clinical outcomes after heart transplantation. Proliferation of the vasa vasorum is associated with arterial inflammation. The contribution of angiogenesis to the development of CAV has been suggested. METHODS: Serial (baseline and 1-year post-transplant) intravascular ultrasound was performed in 102 heart transplant recipients. Periarterial small vessels (PSV) were defined as echolucent luminal structures <1 mm in diameter, located ≤2 mm outside of the external elastic membrane. The signal void structures were excluded when they connected to the coronary lumen (considered as side branches) or could not be followed in ≥3 contiguous frames. The number of PSV was counted at 1-mm intervals throughout the first 50 mm of the left anterior descending artery, and the PSV score was calculated as the sum of cross-sectional values. Patients with a PSV score increase of ≥ 4 between baseline and 1-year post-transplant were classified as the "proliferative" group. Maximum intimal thickness was measured for the entire analysis segment. RESULTS: During the first year post-transplant, the proliferative group showed a greater increase in maximum intimal thickness (0.33 ± 0.36 mm vs 0.10 ± 0.28 mm, p < 0.001) and had a higher incidence of acute cellular rejection (50.0% vs 23.9%, p = 0.025) than the non-proliferative group. On Kaplan-Meier analysis, cardiac death-free survival rate over a median of 4.7 years was significantly lower in the proliferative group than in the non-proliferative group (hazard ratio, 3.10; p = 0.036). CONCLUSIONS: The increase in PSV, potentially representing an angioproliferative response around the coronary arteries, was associated with early CAV progression and reduced survival after heart transplantation.
BACKGROUND: This study investigated the relationship between periarterial neovascularization, development of cardiac allograft vasculopathy (CAV), and long-term clinical outcomes after heart transplantation. Proliferation of the vasa vasorum is associated with arterial inflammation. The contribution of angiogenesis to the development of CAV has been suggested. METHODS: Serial (baseline and 1-year post-transplant) intravascular ultrasound was performed in 102 heart transplant recipients. Periarterial small vessels (PSV) were defined as echolucent luminal structures <1 mm in diameter, located ≤2 mm outside of the external elastic membrane. The signal void structures were excluded when they connected to the coronary lumen (considered as side branches) or could not be followed in ≥3 contiguous frames. The number of PSV was counted at 1-mm intervals throughout the first 50 mm of the left anterior descending artery, and the PSV score was calculated as the sum of cross-sectional values. Patients with a PSV score increase of ≥ 4 between baseline and 1-year post-transplant were classified as the "proliferative" group. Maximum intimal thickness was measured for the entire analysis segment. RESULTS: During the first year post-transplant, the proliferative group showed a greater increase in maximum intimal thickness (0.33 ± 0.36 mm vs 0.10 ± 0.28 mm, p < 0.001) and had a higher incidence of acute cellular rejection (50.0% vs 23.9%, p = 0.025) than the non-proliferative group. On Kaplan-Meier analysis, cardiac death-free survival rate over a median of 4.7 years was significantly lower in the proliferative group than in the non-proliferative group (hazard ratio, 3.10; p = 0.036). CONCLUSIONS: The increase in PSV, potentially representing an angioproliferative response around the coronary arteries, was associated with early CAV progression and reduced survival after heart transplantation.
Authors: Susan Stewart; Gayle L Winters; Michael C Fishbein; Henry D Tazelaar; Jon Kobashigawa; Jacki Abrams; Claus B Andersen; Annalisa Angelini; Gerald J Berry; Margaret M Burke; Anthony J Demetris; Elizabeth Hammond; Silviu Itescu; Charles C Marboe; Bruce McManus; Elaine F Reed; Nancy L Reinsmoen; E Rene Rodriguez; Alan G Rose; Marlene Rose; Nicole Suciu-Focia; Adriana Zeevi; Margaret E Billingham Journal: J Heart Lung Transplant Date: 2005-06-20 Impact factor: 10.247
Authors: Ingrid M Seipelt; Elfriede Pahl; Ralf G Seipelt; Constantine Mavroudis; Carl L Backer; Veronica Stellmach; Mona Cornwell; Susan E Crawford Journal: J Heart Lung Transplant Date: 2005-08 Impact factor: 10.247
Authors: Manolis Vavuranakis; Ioannis A Kakadiaris; Sean M O'Malley; Theodore G Papaioannou; Elias A Sanidas; Morteza Naghavi; Stéphane Carlier; Dimitrios Tousoulis; Christodoulos Stefanadis Journal: Int J Cardiol Date: 2008-02-20 Impact factor: 4.164
Authors: Stephanie H Wilson; Joerg Herrmann; Lilach O Lerman; David R Holmes; Claudio Napoli; Erik L Ritman; Amir Lerman Journal: Circulation Date: 2002-01-29 Impact factor: 29.690
Authors: H M Kwon; G Sangiorgi; E L Ritman; C McKenna; D R Holmes; R S Schwartz; A Lerman Journal: J Clin Invest Date: 1998-04-15 Impact factor: 14.808
Authors: J Herrmann; L O Lerman; M Rodriguez-Porcel; D R Holmes; D M Richardson; E L Ritman; A Lerman Journal: Cardiovasc Res Date: 2001-09 Impact factor: 10.787
Authors: H M Kwon; G Sangiorgi; E L Ritman; A Lerman; C McKenna; R Virmani; W D Edwards; D R Holmes; R S Schwartz Journal: J Am Coll Cardiol Date: 1998-12 Impact factor: 24.094
Authors: Grace W Wu; Jon A Kobashigawa; Michael C Fishbein; Jignesh K Patel; Michelle M Kittleson; Elaine F Reed; Krista K Kiyosaki; Abbas Ardehali Journal: J Heart Lung Transplant Date: 2009-03-14 Impact factor: 10.247