Korean Circ J.  2007 Jan;37(1):9-15. 10.4070/kcj.2007.37.1.9.

Characteristics of Transplant Coronary Artery Disease after Heart Transplantation in Koreans: A Serial Intravascular UltraSound Analysis

• Park KM
• Kim JJ
• Hong MK
• Lee CW
• Kim YH
• Park SW
• Park SJ

• KMID: 2227087
• DOI: http://doi.org/10.4070/kcj.2007.37.1.9

Abstract

BACKGROUND AND OBJECTIVES: Coronary artery disease (CAD) in a transplanted heart has been a major cause of morbidity and mortality for the transplantation patients who survive more than 1 year. The incidence and characteristic pattern of coronary artery disease after heart transplantation in Koreans are not known. The aim of this study is to determine the incidence and characteristics of significant CAD and the coronary arterial remodeling pattern after heart transplantation by using intravascular ultrasound (IVUS).
SUBJECTS AND METHODS
We evaluated a total of 101 consecutive patients who had been examined via serial (over one year interval) IVUS and coronary angiogram. The patients were divided into two groups according to the period of the serial IVUS follow-up. The post-transplant early period (EP) group (n=58) was defined when IVUS was performed within the first month and at one year after heart transplantation, and the post-transplant late period (LP) group (n=43) was defined when IVUS was performed after one year and subsequently over another one year interval.
RESULTS
The CAD-free survival rates, as assessed by coronary angiogram, were 99% at 5 years, 89% at 7 years and 71% at 9 years. In the EP group, 17 patients (29%) had donor lesions and 8 patients (14%) had de novo lesions. For the donor lesions, the diffuse and concentric lesions were 12%, respectively, and the remodeling index was 2.3+/-6.5, which represents a positive remodeling pattern. For the de novo lesion, the diffuse lesions were 25%, the concentric lesions were 13% and the remodeling index was -2.5+/-4.9, which represent a negative remodeling pattern.
CONCLUSIONS
The incidence of significant CAD with diffuse and concentric lesions after heart transplantation was low in Koreans. The coronary arterial remodeling pattern was negative in the early period, and then it became positive during the late period.

Keyword

Heart transplantation; Coronary artery disease; Intravascular ultrasound

MeSH Terms

Coronary Artery Disease*
Coronary Vessels*
Follow-Up Studies
Heart Transplantation*
Heart*
Humans
Incidence
Mortality
Survival Rate
Tissue Donors
Ultrasonography*

Figure

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  Fig. 1 Study design. Patients were subgrouped into an EP group and an LP group. Patients in the EP group were analyzed by IVUS within 1 month after transplantation and then 1 year later. Patients in the LP group were analyzed by IVUS 1 and 3 years after transplantation. HTPL: heart transplantation, EP: post-transplant early period, LP: post-transplant late period, IVUS: intravascular ultrasound.

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  Fig. 2 Intravascular ultrasound (IVUS) images showing the intimal thickness at baseline (A) and after intinal thickness 0.90 mm (B) in one patient, demonstrating de novo lesion. HTPL: heart transplantation, EP: post-transplant early period, LP: post-transplant late period.

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  Fig. 3 Intravascular ultrasound (IVUS) showing a coronary arterial eccentric intimal plaque (A) and a concentric intimal plaque (B).

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  Fig. 4 Calculating the remodeling index (RI). RI was calculated as the change in vessel area/change in the intimal area. An RI ≥1.0 indicates positive remodeling and an RI ≤0 indicates negative remodeling.

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  Fig. 5 Angiographical transplant coronary artery disease (CAD) free survival rate. The angiographically significant coronary artery disease-free survival rate was 99% at 5 year, 89% at 7 year and 71% at 9 year.

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