Intracoronary ultrasound in cardiac transplant recipients. In vivo evidence of "angiographically silent" intimal thickening.

Goar, F. G. Saint; Pinto, Fausto J.; Alderman, Edwin L.; Valantine, Hannah A.; Schroeder, John S.; Gao, Shao-Zhou; Stinson, Edward B.; Popp, Richard L.

doi:10.1161/01.cir.85.3.979

Cited by 407 publications

(130 citation statements)

References 30 publications

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“…11 No attempt was made to classify patients according to the number and distribution of vessels involved because of the diffuse nature of transplant coronary artery disease that is known to already exist by the time stenosis is apparent angiographically. 12 …”

Section: Coronary Angiography In Transplant Recipientsmentioning

confidence: 99%

Cytomegalovirus Infection Impairs the Nitric Oxide Synthase Pathway

et al. 2004

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Background-We hypothesized that cytomegalovirus (CMV) may contribute to the vasculopathy observed in cardiac allograft recipients by impairing the endothelial nitric oxide synthase pathway. We focused on asymmetric dimethylarginine (ADMA, the endogenous inhibitor of nitric oxide synthase) as a potential mediator of the adverse vascular effect of CMV. Methods and Results-Heart transplant recipients manifested elevated plasma ADMA levels compared with healthy control subjects. Transplant patients with CMV DNA-positive leukocytes had higher plasma ADMA concentrations and more extensive transplant arteriopathy (TA). Human microvascular endothelial cells infected with the CMV isolates elaborated more ADMA. The increase in ADMA was temporally associated with a reduction in the activity of dimethylarginine dimethylaminohydrolase (DDAH, the enzyme that metabolizes ADMA). Infected cultures showed high levels of oxidative stress with enhanced endothelial production of superoxide anion. Conclusions-CMV infection in human heart transplant recipients is associated with higher ADMA elevation and more severe TA. CMV infection in endothelial cells increases oxidative stress, impairs DDAH activity, and increases ADMA elaboration. CMV infection may contribute to endothelial dysfunction and TA by dysregulation of the endothelial nitric oxide synthase pathway. (Circulation. 2004;109:500-505.)

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Section: Coronary Angiography In Transplant Recipientsmentioning

confidence: 99%

Cytomegalovirus Infection Impairs the Nitric Oxide Synthase Pathway

et al. 2004

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“…It is well known that angiography systematically underestimates the extent of coronary intimal thickening in cardiac transplant recipients. 12 This study therefore does not attempt to accurately quantify the extent of coronary artery stenosis. Rather the subdivision in groups defined above relies on angiographic data that are easily distinguishable and that have been shown to correlate with histopathologic findings and prognosis.…”

Section: Coronary Angiographymentioning

confidence: 99%

“…After they were washed, the wells were incubated for 1 hour with horseradish peroxidase conjugated rabbit IgG raised against mouse immunoglobulins and washed again. The peroxidase reaction was performed as described earlier, 12 and the absorbance (A) was read at 492 nm. Control subjects without competing ligand and blanks without antibody were included routinely.…”

Section: Assaysmentioning

confidence: 99%

Oxidized Low Density Lipoproteins in Patients With Transplant-Associated Coronary Artery Disease

Holvoet

Stassen

Cleemput

et al. 1998

ATVB

162

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Abstract-The monoclonal antibody 4E6 -based ELISA was used to quantify levels of oxidized LDL in plasma of 65 control subjects, 47 patients transplanted for dilated cardiomyopathy (DCM), and 60 patients transplanted for coronary artery disease (CAD). Levels of oxidized LDL were 0.68Ϯ0.039 mg/dL (meanϮSEM), 1.27Ϯ0.14 mg/dL (PϽ.001 versus control), and 1.73Ϯ0.13 mg/dL (PϽ.001 versus control and Ͻ0.01 versus DCM), respectively. Levels of oxidized LDL were significantly lower in transplanted patients with angiographically normal coronary arteries (grade 0, T he development of CAD after cardiac transplantation is a leading cause of graft failure in recipients who survive the first year after surgery. 1,2 This posttransplant arteriopathy is characterized by rapid development, 3,4 concentric narrowing of smaller coronary arteries, 5,6 and the lack of correlation with known atherogenic risk factors. [1][2][3][4][5][6] Understanding the etiology of accelerated atherosclerosis might allow identification of patients at risk for this complication.It has been suggested that ischemic injury of the heart during the peritransplant period significantly contributes to the development of accelerated atherosclerosis in heart transplant patients. 7 A correlation between LDL oxidation and atherogenesis was first suggested by experiments showing that oxidized LDL mediated injury to endothelial cells (reviewed in Reference 8) and was further supported by studies showing a protective effect of antioxidants against progression of atherosclerosis. 9 The study of the correlation between oxidized LDL and atherosclerosis has, however, been hampered by the lack of a sensitive and specific assay for oxidized LDL in plasma. In the present study we have used an ELISA that is highly specific for oxidized LDL. 10 The ELISA was used to study the association between plasma levels of oxidized LDL and CAD. Methods PatientsThe posttransplant study group contained 47 patients transplanted for DCM and 60 patients treated for CAD. The clinical characteristics of these patients are summarized in Table 1. At the time of blood sampling, between 12 and 84 months after surgery, all patients were in a stable cardiac condition without evidence of acute rejection. Adequate information about the smoking habits was available for 92 of the 107 patients (16 smokers and 76 nonsmokers). There was no adequate information about smoking habits of donors. Rejection was graded by the histopathologic classification of the International Society for Heart and Lung Transplantation. Rejections Ն grade 3A were treated. Maintenance immunosuppression consisted of triple-drug therapy including cyclosporin, azathioprine, and prednisone. Rejection episodes were treated with high-dose intravenous corticosteroids and steroid-resistant rejection with a course of OKT3, a murine anti-CD3 mAb. 11 Cytomegalovirus infection was defined as seroconversion of a seronegative recipient or a fourfold rise in titer postoperatively in a previously cytomegalovirus-positive recipient.Blood samples of 6...

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“…All had undergone scheduled cardiac catheterization and endomyocardial biopsy at 1 week, 2 weeks, 7 weeks, 3 months, 4.5 months, 6 months, 9 months, 1 year, 1.5 years, and then every 6 months or 1 year after transplantation surgery, or when rejection was suspected on the basis of clinical symptoms. Left heart catheterization to obtain LV end-diastolic pressure, as well as coronary angiography with intracoronary ultrasound (IVUS) to detect transplant coronary artery disease (TxCAD), 6) were performed at between 3 and 6 months and then annually after the transplant surgery.…”

Section: Methodsmentioning

confidence: 99%

Clinical Course and Outcome of Heart Transplant Recipients Single Center Experience at the National Cardiovascular Center in Japan

et al. 2010

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SummaryThe number of heart transplant (HTx) surgeries in Japan is expected to increase under the Revised Organ Transplant Law. To date, among 69 HTx surgeries performed in Japan, 27 operations (39.1%) were performed at our institution, the National Cardiovascular Center (NCVC), located in Osaka. We have reviewed the outcomes of HTx conducted at NCVC during a 10 year period (May 1999 to January 2009). Among 27 heart transplant recipients at NCVC, the clinical charts of 26 recipients whose post-HTx period exceeded 1 year were retrospectively reviewed and compared to data from the International Society for Heart and Lung Transplantation (ISHLT) Registry. The survival rate of our recipients was 96.2% at 10.8 years, which was excellent even compared to the ISHLT Registry. The immunosuppressive regimen at NCVC was equivalent to that of the ISHLT Registry, except for more frequent use of Muromonab-CD3 (26.9% versus 3.3%, P < 0.0001) and an initial CSA-based regimen (65.3% versus 34.4%, P < 0.001). The drug we use for induction therapy has been recently changed from Muromonab-CD3 to Basiliximab. The incidences of post-HTx hypertension, diabetes, hyperlipidemia, and renal insufficiency were significantly less in patients at NCVC compared to those in the ISHLT Registry, however, the incidence of transplant coronary artery disease (TxCAD) was almost identical. Clinical review of post-HTx outcome at NCVC can provide useful information for Japanese transplant cardiologists who will engage in HTx management. (Int Heart J 2010; 51: 264-271)

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Intracoronary ultrasound in cardiac transplant recipients. In vivo evidence of "angiographically silent" intimal thickening.

Cited by 407 publications

References 30 publications

Cytomegalovirus Infection Impairs the Nitric Oxide Synthase Pathway

Cytomegalovirus Infection Impairs the Nitric Oxide Synthase Pathway

Oxidized Low Density Lipoproteins in Patients With Transplant-Associated Coronary Artery Disease

Clinical Course and Outcome of Heart Transplant Recipients Single Center Experience at the National Cardiovascular Center in Japan

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