Intravascular Ultrasound Correlates with Coronary Flow Reserve and Predicts the Survival in Angiographically Normal Cardiac Transplant Recipients
Intravascular Ultrasound Correlates with Coronary Flow Reserve and Predicts the Survival in Angiographically Normal Cardiac Transplant Recipients
复制标题
血管内超声与冠状动脉血流储备相关并预测血管造影正常心脏移植受者的生存率
作者：
Chii;Yen;H. Jui;R. Yen;K. Tzen;N. Chou;Shoei
目的：我们的目的是确定心外膜和心肌内动脉是否在早期心脏移植物血管病变中一致受累。研究方法：30名连续接受心脏移植一年以上且冠状动脉血管造影正常的受者入选接受血管内超声（IVUS）、血流储备分数、冠状动脉血流储备和潘生丁铊-201单光子发射计算机断层扫描。移植物衰竭包括心脏性死亡和再次移植作为主要结局。结果如下：在血流储备分数正常的患者亚组中，由IVUS测量计算的斑块体积指数和最大面积狭窄与冠状动脉血流储备恶化相关（n = 13;分别为r =-0.80，p = 0.001和r =-0.91，p <0.0001）。随访18.4 ± 7.6个月后，发现最大面积狭窄是移植物失败的独立预测因素（风险比1.43，95%置信区间1.08-1.89，p = 0.012）。结论：在生理正常的心外膜冠状动脉患者中，微血管完整性受损与IVUS测量的斑块负荷相关，表明心外膜和阻力血管在早期心脏移植物血管病变中的一致参与。尽管冠状动脉造影正常，但IVUS上明显的心外膜冠状动脉狭窄可预测移植失败。
Objectives: We aimed to determine whether epicardial and intramyocardial arteries were involved concordantly in early cardiac allograft vasculopathy. Methods: Thirty consecutive recipients who had received cardiac transplantation more than 1 year before and had a normal coronary angiogram were enrolled for intravascular ultrasound (IVUS), fractional flow reserve, coronary flow reserve and dipyridamole thallium-201 single photon emission computed tomography. Graft failure including cardiac death and retransplantation served as the primary outcome. Results: Plaque volume index and maximum area stenosis calculated from IVUS measurements correlated with coronary flow reserve deterioration in a subgroup of patients with normal fractional flow reserve (n = 13; r = –0.80, p = 0.001 and r = –0.91, p <0.0001, respectively). After follow-up for 18.4 ± 7.6 months, maximum area stenosis was found to be an independent predictor of graft failure (hazard ratio 1.43, 95% confidence interval 1.08–1.89, p = 0.012). Conclusion: In patients with physiologically normal epicardial coronary arteries, impairment of microvascular integrity correlates with the plaque burden measured by IVUS, suggesting the concordant involvement of both epicardial and resistant vessels in early cardiac allograft vasculopathy. Evident epicardial coronary narrowing on IVUS may predict graft failure in spite of normal coronary angiograms.