Introduction: Allograft vascular disease (GVD) is a major determinant of long-term prognosis after heart transplantation. Vascular remodelling plays a key role in GVD development after cardiac transplant. However, determinants and time course of vascular remodelling in heart transplant recipients remain uncertain. Aim of this study was to evaluate determinants and modality of coronary arteries remodelling in heart transplant recipients during the first year of follow-up. Methods: 16 consecutive recipients were included in the study (age 5312 yy, 17% females; donor age 36611yy, ischaemic time 181665 min). Intracoronary ultrasound of left anterior descending (LAD) was performed after one and 12 months from cardiac transplant. Manual planimetry of lumen, total vessel and plaque areas in serial cross sectional images chosen every 2 mm in proximal 30 mm of LAD was performed. Vessel, lumen and plaque volume were calculated. Negative remodelling (NR) was inferred in presence of lumen loss . 5% during the study period. Donors and recipients baseline characteristics as well as rejections and cytomegalovirus (CMV) infections occurrences where analysed. Results: Vessel and plaque volumes increased of 11 and 60% respectively (P50.01), whereas lumen remained unchanged (P50.804), thus suggesting an overall positive remodelling. However, NR was observed in 5 patients (31%). Recipient age was inversely related to NR (P50.03). Notably, donor age and baseline plaque volume were not associated with NR. Moreover, a trend in increased occurrence of CMV infections in patients with NR was noted (60% vs. 18% P50.2). Conclusions: These data suggest that 1) positive vascular remodelling is encountered in the majority of patients after heart transplant. However, 2) inadequate vessel en-largement remains a cause of lumen loss in a subgroup of patients. 3) Donors clinical characteristics and baseline plaque do not determine NR. 4) CMV infections may negatively influence vascular remodelling.

TIME COURSE AND DETERMINANTS OF GRAFT VASCULAR REMODELLING IN HEART TRANSPLANT RECIPIENTS: A PROSPECTIVE STUDY

Grigioni F;
2001-01-01

Abstract

Introduction: Allograft vascular disease (GVD) is a major determinant of long-term prognosis after heart transplantation. Vascular remodelling plays a key role in GVD development after cardiac transplant. However, determinants and time course of vascular remodelling in heart transplant recipients remain uncertain. Aim of this study was to evaluate determinants and modality of coronary arteries remodelling in heart transplant recipients during the first year of follow-up. Methods: 16 consecutive recipients were included in the study (age 5312 yy, 17% females; donor age 36611yy, ischaemic time 181665 min). Intracoronary ultrasound of left anterior descending (LAD) was performed after one and 12 months from cardiac transplant. Manual planimetry of lumen, total vessel and plaque areas in serial cross sectional images chosen every 2 mm in proximal 30 mm of LAD was performed. Vessel, lumen and plaque volume were calculated. Negative remodelling (NR) was inferred in presence of lumen loss . 5% during the study period. Donors and recipients baseline characteristics as well as rejections and cytomegalovirus (CMV) infections occurrences where analysed. Results: Vessel and plaque volumes increased of 11 and 60% respectively (P50.01), whereas lumen remained unchanged (P50.804), thus suggesting an overall positive remodelling. However, NR was observed in 5 patients (31%). Recipient age was inversely related to NR (P50.03). Notably, donor age and baseline plaque volume were not associated with NR. Moreover, a trend in increased occurrence of CMV infections in patients with NR was noted (60% vs. 18% P50.2). Conclusions: These data suggest that 1) positive vascular remodelling is encountered in the majority of patients after heart transplant. However, 2) inadequate vessel en-largement remains a cause of lumen loss in a subgroup of patients. 3) Donors clinical characteristics and baseline plaque do not determine NR. 4) CMV infections may negatively influence vascular remodelling.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/20.500.12610/14283
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