PROSPECTIVE-STUDY OF THE FREQUENCY AND EX TENT OF DONOR-TRANSMITTED CORONARY-ARTERY DISEASE AFTER HEART-TRANSPLANTATION BY INTRAVASCULAR ULTRASOUND

Problem and objective: Cardiac allograft vasculopathy influences long- term survival of patients after heart transplantation. Donor-transmitt ed coronary artery disease may contribute to the further development o f cardiac allograft vasculopathy. The aim of this study was to charact erize by intracoronary ultrasound the extent and frequency of transmit ted coronary artery disease. Patients and methods: Intravascular ultra sound studies were performed at routine angiography in 33 patients (26 men, 7 women, mean age 51 [23-69] years) early after heart transplant ation. Plaque morphology was analysed in 153 coronary segments of 52 e picardial coronary arteries. Results: Relevant atherosclerosis (define d as maximal plaque thickness greater than or equal to 0.5 mm in at le ast one coronary segment) was found in 17 patients (52%), while angiog raphy showed irregularities in only 7 patients (21%). Maximal plaque t hickness in patients with relevant atherosclerosis was 1.13 +/- 0.32 m m, mean plaque index was 19.2 +/- 10.2%. Plaque formation was eccentri c, and plaques were predominantly located in proximal segments. Morpho logic changes affecting more than one segment were found in 52% of the patients. Comparing clinical factors, only donor age predicted the de gree of atherosclerosis. Conclusions: In more than one half of the pat ients studied early after heart transplantation, intravascular ultraso und revealed epicardial atherosclerotic lesions which were incompletel y identified by coronary angiography. The degree of atherosclerosis wa s closely related to donor age. The potential influence of donor trans mitted coronary artery disease on the progression of transplant corona ry artery disease requires further longitudinal studies.