TY - JOUR
T1 - Early constriction or expansion of the external elastic membrane area determines the late remodeling response and cumulative lumen loss in transplant vasculopathy
T2 - An intravascular ultrasound study with 4-year follow-up
AU - Tsutsui, Hiroshi
AU - Schoenhagen, Paul
AU - Ziada, Khaled M.
AU - Crowe, Timothy D.
AU - Klingensmith, Jon D.
AU - Vince, D. Geoffrey
AU - Bott-Silverman, Corinne
AU - Starling, Randall
AU - Hobbs, Robert E.
AU - Young, James
AU - Nissen, Steven E.
AU - Tuzcu, E. Murat
N1 - Funding Information:
Dr. Tsutsui is supported in part by a research grant from the Japanese Association for the Advancement of Medical Equipment, affiliated with the Ministry of Health and Welfare of Japan, Tokyo.
PY - 2003/5/1
Y1 - 2003/5/1
N2 - Background: Early constriction of the external elastic membrane (EEM) area has been observed after cardiac transplantation. The aim of this study was to compare the late disease process of transplant vasculopathy between coronary segments with early constrictive and expansive remodeling. Methods: Serial intravascular ultrasound data obtained annually for 4 years after transplantation in 38 transplant recipients was available. In 135 matched segments from 59 coronary arteries ultrasound images were digitized at 1-mm intervals. Mean values of the external elastic membrane (EEM), lumen and intimal areas were calculated. On the basis of a decrease or increase in EEM area within the first year after transplantation, we defined segments with early constrictive remodeling (CR, n = 71) or early expansive remodeling (ER, n = 64). Results: Annual changes in intimal area were similar between segments with early CR and ER throughout the follow-up period. However, during the second and third year, annual increases in EEM area were greater in segments with early CR than in segments with early ER (second year: 1.5 ± 2.7 vs 0.6 ± 2.8 mm2, p = 0.052; third year: 1.3 ± 2.5 vs -0.03 ± 2.6 mm2, p = 0.003). Despite this late expansion, segments with early CR showed a cumulative decrease in the EEM area and a greater lumen loss than segments with early ER (-2.5 ± 3.4 vs -0.6 ± 2.6 mm2, p < 0.001). Conclusions: In transplant vasculopathy, the late remodeling response was different between segments with early constrictive and expansive remodeling, despite similar intimal thickening. Early constriction caused an overall decrease in EEM area and greater loss of lumen during follow-up.
AB - Background: Early constriction of the external elastic membrane (EEM) area has been observed after cardiac transplantation. The aim of this study was to compare the late disease process of transplant vasculopathy between coronary segments with early constrictive and expansive remodeling. Methods: Serial intravascular ultrasound data obtained annually for 4 years after transplantation in 38 transplant recipients was available. In 135 matched segments from 59 coronary arteries ultrasound images were digitized at 1-mm intervals. Mean values of the external elastic membrane (EEM), lumen and intimal areas were calculated. On the basis of a decrease or increase in EEM area within the first year after transplantation, we defined segments with early constrictive remodeling (CR, n = 71) or early expansive remodeling (ER, n = 64). Results: Annual changes in intimal area were similar between segments with early CR and ER throughout the follow-up period. However, during the second and third year, annual increases in EEM area were greater in segments with early CR than in segments with early ER (second year: 1.5 ± 2.7 vs 0.6 ± 2.8 mm2, p = 0.052; third year: 1.3 ± 2.5 vs -0.03 ± 2.6 mm2, p = 0.003). Despite this late expansion, segments with early CR showed a cumulative decrease in the EEM area and a greater lumen loss than segments with early ER (-2.5 ± 3.4 vs -0.6 ± 2.6 mm2, p < 0.001). Conclusions: In transplant vasculopathy, the late remodeling response was different between segments with early constrictive and expansive remodeling, despite similar intimal thickening. Early constriction caused an overall decrease in EEM area and greater loss of lumen during follow-up.
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U2 - 10.1016/S1053-2498(02)01228-7
DO - 10.1016/S1053-2498(02)01228-7
M3 - Article
C2 - 12742413
AN - SCOPUS:0038667795
SN - 1053-2498
VL - 22
SP - 519
EP - 525
JO - Journal of Heart and Lung Transplantation
JF - Journal of Heart and Lung Transplantation
IS - 5
ER -