Impact of Donor-Transmitted Atherosclerosis on Early Cardiac Allograft Vasculopathy: New Findings by Three-Dimensional Intravascular Ultrasound Analysis

Background. The influence of donor-transmitted coronary atherosclerosis (DA) on plaque progression during the first year after cardiac transplantation (Tx) is unknown. Methods. Serial 3-dimensional intravascular ultrasound (IVUS) studies were performed within 8 weeks (baseline; BL) and at 1 year after Tx in 38 recipients. On the basis of maximum intimal thickness (MIT) at BL, recipients were divided into DA group (DA+; MIT >= 0.5 mm, n=23) or non-DA group (DA+; MIT<0.5 mm, n=15). Plaque, lumen, and vessel volume indexes were calculated by volume/measured length (mm(3)/mm) in the left anterior descending artery. Univariate and multivariate regression analyses were attempted to reveal clinical predictors of change in coronary dimensions. Results. During the first year after Tx, plaque volume index increased significantly in DA+ group, but did not change in DA- Group (DA+, 3.0+/-1.5 to 4.1+/-1.5 mm(3)/mm, P<0.0001: DA-, 1.2+/-0.4 to 1.3+/-0.5 mm(3)/mm, P=0.53). In both groups vessel volume index decreased significantly (DA+, 16.3+/-3.6 to 14.6+/-3.3 mm(3)/mm, P=0.003: DA-, 13.5+/-4.1 to 12.0+/-3.3 mm(3)/mm, P=0.01), as did lumen volume index (DA+, 13.2+/-3.1 to 10.5+/-2.7 mm(3)/mm, P<0.0001: DA-, 12.2+/-3.7 to 10.7+/-3.0 mm(3)/mm, P=0.004). Univariate and multivariate regression analyses revealed that DA was one of the strongest predictors for plaque progression. Conclusions. DA was associated with significant plaque progression during the first year after Tx, and in conjunction with negative remodeling, may be an important determinant of cardiac allograft vasculopathy.