Impact of lipid abnormalities in development and progression of transplant coronary disease: A serial intravascular ultrasound study
Impact of lipid abnormalities in development and progression of transplant coronary disease: A serial intravascular ultrasound study
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DOI：
10.1016/s0735-1097(01)01337-7
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发表时间：
2001-07-01
影响因子：
24
通讯作者：
Tuzcu, EM
中科院分区：
文献类型：
--
作者：
Kapadia, SR;Nissen, SE;Tuzcu, EM
目的应用连续血管内超声成像技术，探讨移植冠状动脉疾病（CAD）发生发展中常见的动脉粥样硬化危险因素的作用。这些疾病过程中的每一个的临床决定因素没有得到很好的表征，血管内超声成像是最敏感的工具，连续研究these processs.Methods移植后0.9 +/- 0.5个月进行基线血管内超声成像，以确定供体动脉粥样硬化。在1.0 ± 0.07年时进行随访成像，以评估供体动脉粥样硬化的进展和移植血管病变的发展。冠心病的传统危险因素包括受者年龄、性别、吸烟史、糖尿病、高血压和高胆固醇血症。随访时，15例患者（42%）出现供体病变进展，42例患者（45%）出现移植血管病变，35例患者（38%）无任何疾病。在有和无移植物血管病变的患者中，任何常规危险因素均无差异。然而，移植物血管病变的严重程度与低密度脂蛋白（LDL）胆固醇较基线的较大增加相关（p = 0.02）。移植后一年的高血清甘油三酯水平和移植前体重指数是唯一显着的预测因素（p = 0.03）的进展供体atherosclerosis.Conclusions传统的动脉粥样硬化的危险因素不预测发展的同种异体移植血管病变，但更大的变化，在移植后的第一年血清低密度脂蛋白胆固醇水平与更严重的血管病变。因此，维持LDL胆固醇尽可能接近移植前的值可能有助于限制获得性移植物血管病变的进展速度。（美国科尔心脏病学杂志2001;38：206-13）（C）2001年美国心脏病学会。
Objective We sought to determine the role of conventional atherosclerosis risk factors in the development and progression of transplant coronary artery disease (CAD) using serial intravascular ultrasound imaging.Background Transplant artery disease is a combination of allograft vasculopathy and donor atherosclerosis. The clinical determinants for each of these disease processes are not well characterized, Intravascular ultrasound imaging is the most sensitive tool to serially study these processes.Methods Baseline intravascular ultrasound imaging was performed 0.9 +/- 0.5 months after transplantation to identify donor atherosclerosis. Follow-up imaging was performed at 1.0 +/- 0.07 year to evaluate progression of donor atherosclerosis and development of transplant vasculopathy. Conventional risk factors for CAD included recipient age, gender, smoking history, diabetes mellitus, hypertension and hypercholesterolemia.Results Donor-transmitted atherosclerosis was present in 36 patients (39%). At follow-up, progression of donor lesions was seen in 15 patients (42%) and 42 patients (45%) developed transplant vasculopathy, leaving 35 patients (38%) without any disease. There was no difference in any conventional risk factors in patients with and without allograft vasculopathy. However, the severity of allograft vasculopathy was associated with a larger increase in low density lipoprotein (LDL) cholesterol from baseline (p = 0.02). High one-year post-transplant serum triglyceride level and pretransplant body mass index were the only significant predictors (p = 0.03) for progression of donor atherosclerosis.Conclusions Conventional atherosclerosis risk factors do not predict development of allograft vasculopathy, but greater change in serum LDL cholesterol level during the first year after transplant is associated with more severe vasculopathy. Therefore, maintenance of LDL cholesterol as close to pretransplant values as possible may elp to limit the rate of progression of acquired allograft vasculopathy. (J Am Coll Cardiol 2001;38:206-13) (C) 2001 by the American College of Cardiology.