Dynamic Nature of Nodular Calcification in Cardiac Allograft Vasculopathy
Dynamic Nature of Nodular Calcification in Cardiac Allograft Vasculopathy
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心脏同种异体移植血管病中结节性钙化的动态性质
DOI：
10.1016/j.jcin.2021.03.042
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发表时间：
2021
期刊：
影响因子：
--
通讯作者：
Sakata Yasushi
中科院分区：
文献类型：
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作者：
Kiyose Yuji;Shiraki Tatsuya;Mizote Isamu;Nakamura Daisuke;Tsukamoto Yasumasa;Yokoi Kensuke;Kioka Hidetaka;Ohtani Tomohito;Hikoso Shungo;Minami Shigeru;Sakata Yasushi
一位50岁男性因缺血性心肌病接受心脏移植。移植后8周，冠状动脉造影显示右冠状动脉轻度狭窄（图1A和1B），光学相干断层扫描（OCT）显示内膜钙化。连续OCT随访证实结节性钙化（NC）呈时间依赖性快速增长（图1C、1D、1E、1F和1G）。5年时，冠状动脉造影显示重度狭窄（图1H和1I），OCT图像显示新生血管延伸至NC（图2）。心脏移植物血管病的特征是由免疫炎症（1）和受损微血管斑块内出血（2）引起的内膜新生血管形成。已知的导致自体冠状动脉NC发生的因素包括冠状动脉口和右冠状动脉中段、血液透析、病变D角大于13和钙化弓大于180（3）。重要的是，患者未接受血液透析，D角为2.2，钙化弓为60。在这种情况下，我们可以观察到内膜新生血管延伸到NC，这表明斑块内出血可能导致NC的快速进展。目前的研究结果将有助于阐明的病因NC。
A50-year-old man underwent heart transplantation due to ischemic cardiomyopathy. At 8 weeks after the transplantation, coronary angiography showed mild stenosis in the right coronary artery (Figures 1A and 1B), and optical coherence tomography (OCT) demonstrated calcified sheets in the intima. Serial OCT follow-up demonstrated the time-dependent rapid growth of nodular calcification (NC)(Figures 1C, 1D, 1E, 1F, and 1G). At 5 years, coronary angiography showed severe stenosis (Figures 1H and 1I), and OCT images showed neovascularization extending into the NC (Figure 2). Cardiac allograft vasculopathy is characterized by the development of intimal neovascularization caused by immunological inflammation (1) and intraplaque hemorrhage from damaged microvessels (2). The known factors that contribute to the development of NC in native coronary arteries is ostium and middle right coronary artery, hemodialysis, lesion D angle of more than 13, and calcified arch of more than 180 (3). Importantly, the patient was not on hemodialysis, the D angle was 2.2, and the calcified arch was 60. In this case, we can observe the intimal neovascularization extending into the NC, suggesting intraplaque hemorrhage might cause the rapid progression of NC. The current findings will contribute to the elucidation of the etiology of NC.