Virtual Histology Assessment of Cardiac Allograft Vasculopathy Following Introduction of Everolimus-Results of a Multicenter Trial

被引:24
作者
Arora, S. [1 ,2 ]
Erikstad, I. [1 ]
Ueland, T. [2 ]
Sigurdardottir, V. [4 ]
Ekmehag, B. [5 ,6 ]
Jansson, K. [7 ]
Eiskjaer, H. [7 ]
Botker, H. E. [8 ]
Mortensen, S. -A. [9 ]
Saunamaki, K. [9 ]
Gude, E. [1 ]
Ragnarsson, A. [1 ]
Solbu, D.
Aukrust, P. [2 ,3 ,10 ]
Gullestad, L. [1 ,10 ]
机构
[1] Oslo Univ Hosp, Rikshosp, Dept Cardiol, Oslo, Norway
[2] Oslo Univ Hosp Rikshosp, Internal Med Res Inst, Oslo, Norway
[3] Oslo Univ Hosp Rikshosp, Sect Clin Immunol & Infect Dis, Oslo, Norway
[4] Sahlgrens Univ Hosp, Transplant Inst, Gothenburg, Sweden
[5] Skane Univ Hosp, Dept Cardiol, Lund, Sweden
[6] Lund Univ, Lund, Sweden
[7] Linkoping Univ Hosp, Ctr Heart, S-58185 Linkoping, Sweden
[8] Skejby Univ Hosp, Dept Cardiol, Aarhus, Denmark
[9] Rigshosp, Dept Cardiol, DK-2100 Copenhagen, Denmark
[10] Univ Oslo, Fac Med, Oslo, Norway
关键词
Cardiac allograft vasculopathy; everolimus; inflammation; virtual histology; VON-WILLEBRAND-FACTOR; INTRAVASCULAR ULTRASOUND; HEART-TRANSPLANTATION; IN-VITRO; ATHEROSCLEROSIS; REJECTION; PLAQUE; IVUS; INFLAMMATION; INHIBITORS;
D O I
10.1111/j.1600-6143.2012.04234.x
中图分类号
R61 [外科手术学];
学科分类号
摘要
In this 12-month multicenter Scandinavian study, 78 maintenance heart transplant (HTx) recipients randomized to everolimus with reduced calcineurin inhibitor (CNI) exposure or continued standard CNI-therapy underwent matched virtual histology (VH) examination to evaluate morphological progression of cardiac allograft vasculopathy (CAV). Parallel measurement of a range of inflammatory markers was also performed. A similar rate of quantitative CAV progression was observed in the everolimus (n = 30) and standard CNI group (n = 48) (plaque index 1.9 +/- 3.8% and 1.6 +/- 3.9%, respectively; p = 0.65). However, VH analysis revealed a significant increase in calcified (2.4 +/- 4.0 vs. 0.3 +/- 3.1%; p = 0.02) and necrotic component (6.5 +/- 8.5 vs. 1.1 +/- 8.6%; p = 0.01) among everolimus patients compared to controls. The increase in necrotic and calcified components was most prominent in everolimus patients with time since HTx >5.1 years and was accompanied by a significant increase in levels of von Willebrand (vWF) factor (p = 0.04) and vascular cell adhesion molecule (VCAM) (p = 0.03). Conversion to everolimus and reduced CNI is associated with a significant increase in calcified and necrotic intimal components and is more prominent in patients with a longer time since HTx. A significant increase in vWF and VCAM accompanied these qualitative changes and the prognostic implication of these findings requires further investigation.
引用
收藏
页码:2700 / 2709
页数:10
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