This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (1) Citing Articles via Google Scholar Google Scholar Articles by Raichlin, E. Articles by Lerman, A. Search for Related Content PubMed PubMed Citation Articles by Raichlin, E. Articles by Lerman, A. Related Collections Related Articles

CLINICAL RESEARCH: HEART FAILURE

Inflammatory Burden of Cardiac Allograft Coronary Atherosclerotic Plaque Is Associated With Early Recurrent Cellular Rejection and Predicts a Higher Risk of Vasculopathy Progression

Eugenia Raichlin, MD^_*,, Jang-Ho Bae, MD, Sudhir S. Kushwaha, MD^_*, Ryan J. Lennon, MS, Abhiram Prasad, MD^_*, Charanjit S. Rihal, MD^_* and Amir Lerman, MD^_*,,_*

^_* Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
Center for Coronary Physiology and Imaging, Mayo Clinic, Rochester, Minnesota
Division of Biostatistics, Mayo Clinic, Rochester, Minnesota

Manuscript received July 22, 2008; revised manuscript received December 2, 2008, accepted December 8, 2008.

^_* Reprint requests and correspondence: Dr. Amir Lerman, Division of Cardiovascular Disease, Mayo Clinic, Mary Bright 4-523, First Street SW, Rochester, Minnesota 55905 (Email: Lerman.Amir{at}mayo.edu).

Objectives: This study was designed to investigate tissue characterization of the coronary allograft atherosclerotic plaque with virtual histology intravascular ultrasound (VH-IVUS) imaging to assess the presence and predictors of vessel wall inflammation and its significance in cardiac allograft vasculopathy (CAV) progression.

Background: A unique form of accelerated atherosclerosis, CAV remains the leading cause of late morbidity and mortality in heart transplant patients. The pathogenesis of CAV is not fully elucidated.

Methods: A total of 86 patients with coronary allograft vasculopathy underwent VH-IVUS examination of the left anterior descending coronary artery 3.61 ± 3.04 years following cardiac transplantation. Based on the VH-IVUS plaque characteristics, coronary allograft plaque was divided on virtual histology intravascular ultrasound-derived "inflammatory" (VHD-IP) (necrotic core and dense calcium 30%) and "noninflammatory" plaque (VHD-NIP) (necrotic core and dense calcium <30%). Total rejection scores were calculated based on the 2004 International Society of Heart and Lung Transplantation rejection grading system.

Results: In the whole study population, the mean percentage of fibrous, fibrofatty, dense calcified, and necrotic core plaques in a mean length of 62.3 ± 17.4 mm of the left anterior descending coronary artery were 50 ± 17%, 16 ± 11%, 15 ± 11%, and 18 ± 9%, respectively. Patients with a 6-month total rejection score >0.3 had significantly higher incidence of VHD-IP than those with a 6-month total rejection score 0.3 (69% vs. 33%, p = 0.011). The presence of VHD-IP at baseline was associated with a significant increase in plaque volume (2.42 ± 1.78 mm³/mm vs. –0.11 ± 1.65 mm³/mm, p = 0.010), plaque index (7 ± 9% vs. 0 ± 8%, p = 0.04), and remodeling index (1.24 ± 0.44 vs. 1.09 ± 0.36, p = 0.030) during 12 months of follow-up when compared with the presence of VHD-NIP at baseline and during follow-up.

Conclusions: The presence of VHD-IP as assessed by VH-IVUS is associated with early recurrent rejection and with higher subsequent progression of CAV. A VH-IVUS assessment may add important information in the evaluation of transplant recipients.

Key Words: cardiac transplantation • rejection • coronary allograft • vasculopathy • intravascular ultrasound

Abbreviations and Acronyms   CAV = coronary allograft vasculopathy   hsCRP = high-sensitivity C-reactive protein   R = rejection grade   TRS = total rejection score   VHD-IP = virtual histology intravascular ultrasound-derived inflammatory plaque   VHD-NIP = virtual histology intravascular ultrasound-derived noninflammatory plaque   VH-IVUS = virtual histology intravascular ultrasound

Related Articles

Virtual Histology Intravascular Ultrasound: Assessing the Risk of Cardiac Allograft Vasculopathy

Richard D. Patten
J. Am. Coll. Cardiol. 2009 53: 1287-1288. [Full Text] [PDF]

This article has been cited by other articles:

				Y. Topilsky, T. Hasin, E. Raichlin, B. A. Boilson, J. A. Schirger, N. L. Pereira, B. S. Edwards, A. L. Clavell, R. J. Rodeheffer, R. P. Frantz, et al. Sirolimus as Primary Immunosuppression Attenuates Allograft Vasculopathy With Improved Late Survival and Decreased Cardiac Events After Cardiac Transplantation Circulation, February 7, 2012; 125(5): 708 - 720. [Abstract] [Full Text] [PDF]

				A. Schober, M. Hristov, S. Kofler, R. Forbrig, B. Lohr, N. Heussen, Z. Zhe, S. Akhtar, U. Schumann, F. Krotz, et al. CD34+CD140b+ cells and circulating CXCL12 correlate with the angiographically assessed severity of cardiac allograft vasculopathy Eur. Heart J., February 2, 2011; 32(4): 476 - 484. [Abstract] [Full Text] [PDF]

				R. J. Zimmer and M. S. Lee Transplant Coronary Artery Disease J. Am. Coll. Cardiol. Intv., April 1, 2010; 3(4): 367 - 377. [Abstract] [Full Text] [PDF]

				R. D. Patten Virtual Histology Intravascular Ultrasound: Assessing the Risk of Cardiac Allograft Vasculopathy J. Am. Coll. Cardiol., April 14, 2009; 53(15): 1287 - 1288. [Full Text] [PDF]