Compensatory enlargement in transplant coronary artery disease: an intravascular ultrasound study

作     者：LI Hai-yan Koji Tanaka Brandy Oeser Brett Wertman Jon A. Kobashigawa Jonathan M. Tobis 

作者机构：Division of Cardiology Department of Medicine University ofCalifornia Los Angeles David Geffen School of Medicine LosAngeles California 90095 USA Department of Cardiology Peking University Third HospitalBeijing 100083 China 

出 版 物：《Chinese Medical Journal》 (中华医学杂志（英文版）)

年 卷 期：2006年第119卷第7期

页      面：564-569页

核心收录：

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

主　　题：transplant coronary artery disease compensatory enlargement intravascular ultrasound 

摘      要：Background It is unclear to what extent the ＂Glagov phenomenon＂ occurs in transplant coronary artery disease （TCAD）. The objective of this study was to evaluate the relationship between intimal hyperplasia and compensatory enlargement in TCAD. Methods Intravascular ultrasound imaging was performed on 190 cardiac transplant recipients at （1.4±0.6） months and again （12.1±0.7） months after cardiac transplantation. Studies 1 year apart were matched at 625 sites. There were 545 coronary artery sites that had an increase in intimal area 〉10% from baseline to one year, and this comprised the data set of the present study. Results At the first year, 91% of coronary artery sites with intimal growth had a total cross-sectional area stenosis ≤40%, but 38% of the sites showed a decrease of 〉10% in lumen area. Receiver operating characteristic curve demonstrated that the change in cross-sectional area stenosis cut-off level at year 1 was 8% with a sensitivity of 75% and a specificity of 82% in predicting lumen loss. At a total cross-sectional area stenosis of 20%, sensitivity was 65% with a specificity of 81% in predicting lumen loss. Conclusions In TCAD, vessel enlargement as a compensatory mechanism for plaque growth is generally inadequate. Instead of continued vessel expansion, luminal narrowing develops when there is more than 8% cross-sectional area filled with intimal hyperplasia. In distinction to native coronary artery atherosclerotic disease, the transition point in transplant vasculopathy where the lumen is diminished by increasing intimal growth, occurs at a lower threshold, 20% vs 40% of vessel crossectional area.