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

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

Research output: Contribution to journalArticlepeer-review

6 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)752-759
Number of pages8
JournalJournal of Heart and Lung Transplantation
Volume35
Issue number6
DOIs
StatePublished - Jun 1 2016
Externally publishedYes

Keywords

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

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine
  • Transplantation

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