Characteristics of Transplant Coronary Artery Disease after Heart Transplantation in Koreans: A Serial Intravascular UltraSound Analysis

ABSTRACT

BACKGROUND AND OBJECTIVES: Coronary artery disease (CAD) in a transplanted heart has been a major cause of morbidity and mortality for the transplantation patients who survive more than 1 year. The incidence and characteristic pattern of coronary artery disease after heart transplantation in Koreans are not known. The aim of this study is to determine the incidence and characteristics of significant CAD and the coronary arterial remodeling pattern after heart transplantation by using intravascular ultrasound (IVUS). SUBJECTS AND METHODS: We evaluated a total of 101 consecutive patients who had been examined via serial (over one year interval) IVUS and coronary angiogram. The patients were divided into two groups according to the period of the serial IVUS follow-up. The post-transplant early period (EP) group (n=58) was defined when IVUS was performed within the first month and at one year after heart transplantation, and the post-transplant late period (LP) group (n=43) was defined when IVUS was performed after one year and subsequently over another one year interval. RESULTS: The CAD-free survival rates, as assessed by coronary angiogram, were 99% at 5 years, 89% at 7 years and 71% at 9 years. In the EP group, 17 patients (29%) had donor lesions and 8 patients (14%) had de novo lesions. For the donor lesions, the diffuse and concentric lesions were 12%, respectively, and the remodeling index was 2.3+/-6.5, which represents a positive remodeling pattern. For the de novo lesion, the diffuse lesions were 25%, the concentric lesions were 13% and the remodeling index was -2.5+/-4.9, which represent a negative remodeling pattern. CONCLUSIONS: The incidence of significant CAD with diffuse and concentric lesions after heart transplantation was low in Koreans. The coronary arterial remodeling pattern was negative in the early period, and then it became positive during the late period.