Clinical study
Incidence and severity of transplant coronary artery disease early and up to 15 years after transplantation as detected by intravascular ultrasound☆,☆☆

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Abstract

Objectives. The purpose of this study was to quantify the severity of transplant coronary artery disease and to assess lesion characteristics early and up to 15 years after heart transplantation by using intracoronary ultrasound.

Background. Intravascular ultrasound has the ability to measure the components of the arterial wall and has been shown to be a sensitive method for detection of transplant coronary artery disease.

Methods. A total of 304 intracoronary ultrasound studies were performed in 174 heart transplant recipients at baseline and up to 15 (mean 3.3 ± 0.2) years after transplantation. Mean intimal thickness and an intimal index were calculated, and lesion characteristics (eccentricity, calcification) were assessed for all coronary sites imaged (mean 3.0 ± 0.1 sites/study). The Stanford classification was used to grade lesion severity.

Results. Compared with findings in patients studied at baseline (<2 months after transplantation, n = 50), mean intimal thickness (0.09 ± 0.02 vs. 0.16 ± 0.02 mm, p < 0.01), intimal index (0.07 ± 0.01 vs. 0.14 ± 0.02, p < 0.01) and mean severity class (1.5 ± 0.2 vs. 2.3 ± 0.2, p < 0.01) were significantly higher at year 1 (n = 52) after transplantation. Thereafter, all three variables further increased over time and reached highest values between years 5 and 15. Calcification of lesions was detected in 2% to 12% of studies up to 5 years after transplantation, with a significant increase to 24% at years 6 to 10 (p < 0.05).

Conclusions. Severity of transplant coronary artery disease appeared to progress with time after transplantation in this cross-sectional study. This characteristic was most prominent during the 1st 2 years after transplantation, whereas calcification of plaques occurred to a significant extent only later in the process. These data may serve as a reference for comparison of intravascular ultrasound findings in other studies of patients with transplant coronary artery disease.

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☆

This study was presented in part at the Joint XIIth World Congress of Cardiology and XVIth Congress of the European Society of Cardiology, Berlin, Germany, September 1994.

☆☆

This work was also supported in part by the Butterway Fund, Stanford University, Stanford, California.

1

Dr. Rickenbacher is the recipient of a grant from the Margarete and Walther Lichtenstein Foundation, Basel, Switzerland

2

Dr. Pinto was the recipient of a Fellowship Award from the Fundaçao Calouste Gulbenkian, Lisbon, Portugal

3

Dr. Chenzbraun was supported in part by the Israeli Heiden Fellowship, Jerusalem, Israel and by the American Physicians Fellowship, Brookline, Massachusetts

4

Dr. Lewis is supported by the British Heart Foundation, London, England

6

Dr. Popp is a consultant to and holds stock options with CVIS, Inc, Sunnyvale, California, manufacturer of the imaging system used.

5

Dr. Yeung is supported by Clinical Investigator Development Award K08-HL027 87 from the National Institutes of Health, Bethesda, Maryland

Copyright © 1995 Published by Elsevier Inc.