The topography of intimal thickening and associated remodeling pattern of early transplant coronary disease: Influence of pre-existent donor atherosclerosis

Background: With native coronary disease, intimal plaque initially accumula tes at focal areas in the artery, often accompanied by compensatory vessel enlargement. With transplant coronary disease, the topography of intimal th ickening and associated remodeling pattern are less studied. Methods: We studied 72 prospectively recruited transplant patients with ser ial intravascular ultrasound using 4.3F catheters at baseline and at 1-year follow up. We considered 175 ultrasound-recorded segments (mean, 2.4 +/- 1 .1 segments per patient) exactly matched on the serial studies by both angi ographic criteria and ultrasound criteria, using arterial and venous branch points, pericardium, and sinuses as anatomic landmarks. Results: Eighty-eight segments had no donor disease, and 87 had donor disea se (80 eccentric and 7 concentric intimal thickening). Progressive intimal thickening occurred in 48 segments without (55%) and 43 segments with donor disease (48%, p = NS). Thickening from segments without donor disease was mainly eccentric (81%). Thickening from segments with donor eccentric plaqu e was also mainly eccentric (67%, p = NS compared with segments without don or disease), with further thickening superimposed on the original plaque. C oncentric intimal thickening was uncommon. Of the 58 patients who had >1 se gment matched, intimal changes were discordant in 34 (59%), with progressio n in some and lack of progression in other segments. Total vessel area chan ge correlated with intimal area change (r = 0.37 with a slope of 0.79, p < 0.001), including segments with (r = 0.39; slope, 0.69) and segments withou t (r = 0.37; slope, 1.16) donor disease. Conclusion: The intimal thickening of early transplant coronary disease is mainly eccentric and often discordant within each individual patient. Donor eccentric plaque often serves as a nidus for further intimal growth. The t opography of intimal thickening in transplant coronary disease resembles th at of native coronary disease, but the presence of a pre-existent donor pla que may impede compensatory remodeling as further intimal thickening occurs after transplantation.