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Coronary Dilatation After Heart Transplantation.
MedLine Citation:
PMID:  21799467     Owner:  NLM     Status:  Publisher    
BACKGROUND.: The angiographic incidence of coronary dilatation (CD) in the nontransplant population is approximately 0.2% to 5%. The endothelial-dependent and -independent causes for CD are postulated. So far, the incidence and prognosis of CD after heart transplantation is unknown. METHODS.: We retrospectively analyzed the annual coronary angiographies of 688 heart transplant recipients regarding the incidence of CD (defined as ≥1.5-fold localized increased vessel diameter or diffuse dilatation involving more than 50% of the coronary artery). A subgroup analysis of coronary epicardial (quantitative angiography) and microvascular (doppler flow measurement) vasomotor function in response to acetylcholine (endothelial dependent) and adenosine (endothelial independent) as well as intravascular ultrasound was performed in 177 patients. RESULTS.: CD was detectable in 26 patients (3.8%) and was associated with stenosing coronary artery disease in 27% of the patients. Segments with CD tended to have less intimal hyperplasia compared with nondilated segments. A diffuse dilatation (type I-II) was present in 63% of the recipients. The right coronary artery was always involved. The patients with CD (5 of 177) showed a 31% reduced flow velocity in the dilated coronaries compared with the nondilated coronary arteries (P=0.03). Microvascular endothelial-independent function was impaired in CD by -29% (coronary flow reserve mean 1.9 vs. 2.7; P=0.04), whereas endothelial-dependent response was unchanged. Epicardial endothelial-dependent and -independent responses were not different between the groups. Incidence of CD was not associated with limited survival. CONCLUSION.: The incidence of CD in the nontransplant population is similar to that in the transplanted population. However, the latter shows a more diffuse extent. Heart transplantation patients with CD had microvascular endothelial-independent functional limitations and flow deceleration, whereas survival was not affected.
Thomas Nickel; Amir Bigdeli; Franz von Ziegler; Ute Wilbert-Lampen; Korbinian Lackermair; Sophia Horster; Eva Hoster; Peter Uberfuhr; Wolfgang von Scheidt; Michael Weis; Ingo Kaczmarek
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-7-26
Journal Detail:
Title:  Transplantation     Volume:  -     ISSN:  1534-6080     ISO Abbreviation:  -     Publication Date:  2011 Jul 
Date Detail:
Created Date:  2011-7-29     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0132144     Medline TA:  Transplantation     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
1 Medizinische Klinik und Poliklinik 1, Campus Großhadern, Ludwig- Maximilians Universität, Munich, Germany. 2 Department of Cardiac Surgery, Campus Großhadern, Ludwig-Maximilians Universität, Munich, Germany. 3 Institute for Medical Informatics Biometry and Epidemiology, Ludwig-Maximilians Universität, Munich, Germany. 4 Department of Gastro-Enterology, Campus Grosshadern, Ludwig- Maximilians Universität, Munich, Germany. 5 Department of Cardiology, Klinikum Augsburg, Augsburg, Germany.
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