CYTOMEGALOVIRUS-INFECTION ACCELERATES CARDIAC ALLOGRAFT VASCULOPATHY - CORRELATION BETWEEN ANGIOGRAPHIC AND ENDOMYOCARDIAL BIOPSY FINDINGS IN HEART-TRANSPLANT PATIENTS

In order to determine the impact of cytomegalovirus (CMV) infection on cardiac allograft vasculopathy (CAV), we quantitated angiograms and e ndomyocardial biopsy (EMB) specimens obtained from 53 heart transplant recipients. CMV infection was particularly associated with the develo pment of discrete stenosis in major branch vessels (P < 0.03). Also, t he number of diffusely affected vessel segments was significantly high er in CMV patients than in CMV-free recipients after the 2nd postopera tive year (P < 0.05). The EMB histology correlated well with angiograp hy. Significantly higher levels of arteriolar endothelial cell prolife ration and intimal thickness were recorded in biopsies of CMV patients than in those of CMV-free recipients during the 1 st postoperative ye ar (P < 0.02 and P < 0.005, respectively). The CMV-associated vascular changes in EMB histology clearly preceded angiographically detectable CAV findings. Taken together, CMV infection accelerated heart allogra ft arteriosclerosis. The histological changes appeared prior to change s detected by coronary angiography. The CMV effect was particularly pr onounced during the first 2 post-transplant years but leveled off ther eafter. Thus, CMV-accelerated allograft arteriosclerosis may be linked in particular with early graft loss of CMV-infected heart transplant recipients.