Role of compensatory enlargement and shrinkage in transplant coronary artery disease. Serial intravascular ultrasound study.
Role of compensatory enlargement and shrinkage in transplant coronary artery disease. Serial intravascular ultrasound study.
复制标题
代偿性扩张和收缩在移植冠状动脉疾病中的作用。
DOI：
10.1161/01.cir.95.4.855
复制
发表时间：
1997
期刊：
影响因子：
37.8
通讯作者：
Yeung,AC
中科院分区：
文献类型：
--
作者：
Lim,TT;Liang,DH;Botas,J;Schroeder,JS;Oesterle,SN;Yeung,AC
背景血管壁代偿性增大在动脉粥样硬化的早期阶段已被描述。代偿性增大是否在移植冠状动脉疾病中起作用尚不清楚。本研究的目的是利用系列血管内超声(IVUS)来确定移植冠状动脉疾病是否随时间发生代偿性扩张。方法和结果选择75例心脏移植受者，151个匹配的冠状动脉节段，根据IVUS连续检查1~3年发现的血管内膜病变进展情况。血管内膜疾病进展定义为内膜面积(IA)增加10%。随访研究中的静脉内超声导管位置通过与分支血管相关的血管造影术得到证实。测量每个部位的管腔面积(LA)和总血管面积(TA)。计算内膜面积(IA=TA、−、LA)。比较治疗前后IA(ΔIA)和TA(ΔTA)的变化：ΔIA为2.9±0.2mm2，ΔTA为2.7±0.4mm2。重塑指数(RI)定义为RI=ΔTA/ΔIA。可分为三个亚组：过度代偿(RI>；1)、部分代偿(RI 0~1)和无代偿或收缩(RI≤0)。74个节段(49%)表现为过度代偿，44个节段(29%)表现为部分代偿，33个节段(22%)表现为无代偿或收缩。然而，相当数量的冠状动脉节段(22%)没有显示代偿性扩张或收缩。移植患者的进行性管腔狭窄可能部分是由于血管收缩或随着时间的推移缺乏代偿性扩张。
BackgroundCompensatory enlargement of the vessel wall has been described in the early stages of native atherosclerosis. Whether compensatory enlargement plays a role in transplant coronary artery disease is not known. The objective of this study was to determine, by use of serial intravascular ultrasound (IVUS), whether compensatory dilation occurs in transplant coronary artery disease over time.Methods and ResultsSeventy-five heart transplant recipients with 151 matched coronary segments were selected for the presence of intimal disease progression as detected by serial IVUS examinations 1 to 3 years apart. Intimal disease progression was defined as a >10% increase in intimal area (IA). IVUS catheter location in follow-up studies was verified angiographically in relation to branch vessels. Luminal area (LA) and total vessel area (TA) were measured at each site. Intimal area (IA=TA−LA) was calculated. Changes in IA (ΔIA) and TA (ΔTA) between baseline and follow-up IVUS were compared: ΔIA, 2.9±0.2 mm2; ΔTA, 2.7±0.4 mm2. A remodeling index (RI) was defined as RI=ΔTA/ΔIA. Three subgroups could be distinguished: overcompensation (RI >1), partial compensation (RI 0 to 1), and no compensation or shrinkage (RI ≤0). Seventy-four segments (49%) showed overcompensation, 44 (29%) showed partial compensation, and 33 (22%) showed no compensation or shrinkage.ConclusionsIn this study, serial IVUS shows that early after cardiac transplantation, a large proportion of the coronary segments with progression of intimal thickening have compensatory dilation of the vessel wall. However, a substantial number of coronary segments (22%) show no compensatory dilation or shrinkage. The progressive luminal narrowing in transplant patients may be due in part to vessel shrinkage or the lack of compensatory dilation over time.