Heterogeneity of cardiac allograft vasculopathy: Clinical insights from coronary angioscopy

Mehra, Mandeep R., Ventura, Hector O., Jain, Suresh P., Ramireddy, Keshav, Ali, Arshad, Stapleton, Dwight D., Smart, Frank W., Ramee, Stephen R., Collins, Tyrone J. and White, Christopher J. (1997) Heterogeneity of cardiac allograft vasculopathy: Clinical insights from coronary angioscopy. Journal of the American College of Cardiology, 29 6: 1339-1344. doi:10.1016/S0735-1097(97)00059-4

Author Mehra, Mandeep R.
Ventura, Hector O.
Jain, Suresh P.
Ramireddy, Keshav
Ali, Arshad
Stapleton, Dwight D.
Smart, Frank W.
Ramee, Stephen R.
Collins, Tyrone J.
White, Christopher J.
Title Heterogeneity of cardiac allograft vasculopathy: Clinical insights from coronary angioscopy
Journal name Journal of the American College of Cardiology   Check publisher's open access policy
ISSN 0735-1097
Publication date 1997-05
Sub-type Article (original research)
DOI 10.1016/S0735-1097(97)00059-4
Volume 29
Issue 6
Start page 1339
End page 1344
Total pages 6
Place of publication San Diego, CA, United States
Publisher Elsevier
Language eng
Formatted abstract
Objectives: With this study, we sought to examine the heterogeneity of cardiac allograft vasculopathy in vivo using coronary angioscopy as an adjunct to intravascular ultrasound, and we evaluated the clinical relations of immunologic and nonimmunologic risk factors with the different forms of cardiac allograft vasculopathy detected angioscopically.

Background: Intravascular ultrasound detects vascular intimal proliferation accurately but is limited in its ability to delineate morphologic characteristics. Coronary angioscopy can evaluate intimal surface morphology by direct visualization and can differentiate pathologically distinct forms of plaque topography on the basis of color and contour.

Methods: We studied 107 consecutive heart transplant recipients with intravascular ultrasound and angioscopy at the time of their annual angiogram, and we assessed the relation of nonimmunologic and immunologic risk factors to the development of cardiac allograft vasculopathy distinguished angioscopically into a pigmented (yellow) or nonpigmented (white) intimal thickening. We further evaluated the clinical differences in cardiac events among these two forms of angioscopically heterogeneous forms of cardiac allograft vasculopathy.

Results: Significant clinical predictors of nonpigmented intimal thickening were advanced donor age and lower mean cyclosporine levels, whereas hyperlipidemia, cumulative prednisone dose and time since transplantation correlated with pigmented intimal hyperplasia. In addition, comparisons between the two angioscopic groups revealed increased intimal thickening, serum cholesterol, low density lipoprotein cholesterol, acute allograft rejection and time since transplantation in the group with pigmented intimal thickening (p < 0.05). With regard to cardiac events, nonpigmented plaque was more frequently found in the sudden death group (53% vs. 20%, p = 0.05), whereas the nonsudden cardiac event group had a significantly higher prevalence of pigmented plaque (80% vs. 47%, p = 0.07).

Conclusions: These findings indicate that cardiac allograft vasculopathy is a heterogeneous disease with varied morphologic expressions with different clinical implications. Furthermore, this investigation provides insight into the cohesive, yet diverse influences of various factors, particularly immunosuppression, in these forms of cardiac allograft vasculopathy.
Keyword Cyclosporin
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collection: School of Medicine Publications
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Citation counts: TR Web of Science Citation Count  Cited 16 times in Thomson Reuters Web of Science Article | Citations
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Created: Mon, 14 Mar 2011, 10:11:36 EST