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CLINICAL STUDIES

Volumetric remodeling of the proximal left coronary artery

Early versus late after heart transplantation¹

^a Department of Thoracic and Cardiovascular Surgery, Hannover Medical School, Hannover, Germany

Manuscript received July 14, 1998; revised manuscript received January 7, 1999, accepted March 15, 1999.

Reprint requests and correspondence: Klaus Pethig, MD, Department of Thoracic and Cardiovascular Surgery, Division of Surgery, Hannover Medical School, D-30623 Hannover, Germany
Klaus.Pethig{at}t-online.de

OBJECTIVES

The aim of this study was to characterize progression of cardiac allograft vasculopathy (CAV) with special respect to coronary artery geometry.

BACKGROUND

As previously shown by intravascular ultrasound (IVUS), CAV is characterized by a multifocal intimal hyperplasia. Little is known, however, about vascular remodeling processes influencing vessel geometry and luminal narrowing.

METHODS

In 30 heart transplant recipients serial IVUS studies were performed at baseline (BL) and after a mean follow-up period of 12.5 ± 2.5 months. Changes in plaque, lumen and vessel volume were assessed in the proximal left anterior descending artery. Pattern of remodeling was analyzed in patients "early" (n = 15, BL study 1.4 ± 0.7 months after heart transplantation [HTX]) compared with "late" after HTX (n = 15, BL 46.1 ± 29.1 months).

RESULTS

Plaque volume was found to increase by a mean of 23.8 ± 25.9 mm³, not significantly different within and beyond the 1st year after HTX. Significant differences, however, were observed in changes in vessel volume with a mean decrease of –52.8 ± 70.9 mm³ in the early group, whereas late follow-up group presented with an enlargement of 32.3 ± 46.0 mm³. Based on these changes, lumen volume decreased by –73.2 ± 69.8 mm³ early, in contrast to a slight increase of 5.2 ± 32.6 mm³ in the late group.

CONCLUSIONS

Progression of CAV is a complex process, modified by changes in the vascular geometry. Especially within the 1st year after HTX, luminal loss is influenced not only by an increase in plaque area but by a decrease in total vessel volume as well.

Abbreviations and Acronyms   HTX = heart transplantation   IVUS = intravascular ultrasound   LAD = left anterior descending artery

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