Association of periarterial neovascularization with progression of cardiac allograft vasculopathy and long-term clinical outcomes in heart transplant recipients

作者：Kitahara Hideki; Okada Kozo; Tanaka Shigemitsu; Yang Hyoung Mo; Miki Kojiro; Kobayashi Yuhei; Kimura Takumi; Luikart Helen; Yock Paul G; Yeung Alan C; Fitzgerald Peter J; Khush Kiran K; Fearon William F; Honda Yasuhiro^*

来源：Journal of Heart and Lung Transplantation, 2016, 35(6): 752-759.

DOI：10.1016/j.healun.2016.02.002

• cardiac allograft vasculopathy
• neovascularization
• intravascular ultrasound
• heart transplantation
• periarterial small vessels

BACKGROUND: This study investigated the relationship between periarterial neovascularization, development of cardiac allograft vasculopathy (CAV), and long-term clinical outcomes after heart transplantation. Proliferation of the vasa vasorum is associated with arterial inflammation. The contribution of angiogenesis to the development of CAV has been suggested.
METHODS: Serial (baseline and 1-year post-transplant) intravascular ultrasound was performed in 102 heart transplant recipients. Periarterial small vessels (PSV) were defined as echolucent luminal structures <1 mm in diameter, located <= 2 mm outside of the external elastic membrane. The signal void structures were excluded when they connected to the coronary lumen (considered as side branches) or could not be followed in >= 3 contiguous frames. The number of PSV was counted at 1-mm intervals throughout the first 50 mm of the left anterior descending artery, and the PSV score was calculated as the sum of cross-sectional values. Patients with a PSV score increase of >= 4 between baseline and 1 year post-transplant were classified as the "proliferative" group. Maximum intimal thickness was measured for the entire analysis segment.
RESULTS: During the first year post-transplant, the proliferative group showed a greater increase in maximum intimal thickness (0.33 +/- 0.36 mm vs 0.10 +/- 0.28 mm, p < 0.001) and had a higher incidence of acute cellular rejection (50.0% vs 23.9%, p = 0.025) than the non-proliferative group. On Kaplan-Meier analysis, cardiac death-free survival rate over a median of 4.7 years was significantly lower in the proliferative group than in the non-proliferative group (hazard ratio, 3.10; p = 0.036).
CONCLUSIONS: The increase in PSV, potentially representing an angioproliferative response around the coronary arteries, was associated with early CAV progression and reduced survival after heart transplantation.

• 出版日期2016-6