Document Detail

Effect of rapamycin therapy on coronary artery physiology early after cardiac transplantation.
MedLine Citation:
PMID:  18440337     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Rapamycin has been shown to reduce anatomical evidence of cardiac allograft vasculopathy, but its effect on coronary artery physiology is unknown.
METHODS: Twenty-seven patients without angiographic evidence of coronary artery disease underwent measurement of fractional flow reserve (FFR), coronary flow reserve (CFR), and the index of microcirculatory resistance (IMR) within 8 weeks and then 1 year after transplantation using a pressure sensor/thermistor-tipped guidewire. Measurements were compared between consecutive patients who were on rapamycin for at least 3 months during the first year after transplantation (rapamycin group, n = 9) and a comparable group on mycophenolate mofetil (MMF) instead (MMF group, n = 18).
RESULTS: At baseline, there was no significant difference in FFR, CFR, or IMR between the 2 groups. At 1 year, FFR declined significantly in the MMF group (0.87 +/- 0.06 to 0.82 +/- 0.06, P = .009) but did not change in the rapamycin group (0.91 +/- 0.05 to 0.89 +/- 0.04, P = .33). Coronary flow reserve and IMR did not change significantly in the MMF group (3.1 +/- 1.7 to 3.2 +/- 1.0, P = .76; and 27.5 +/- 18.1 to 19.1 +/- 7.6, P = .10, respectively) but improved significantly in the rapamycin group (2.3 +/- 0.8 to 3.8 +/- 1.4, P < .03; and 27.0 +/- 11.5 to 17.6 +/- 7.5, P < .03, respectively). Multivariate regression analysis revealed that rapamycin therapy was an independent predictor of CFR and FFR at 1 year after transplantation.
CONCLUSION: Early after cardiac transplantation, rapamycin therapy is associated with improved coronary artery physiology involving both the epicardial vessel and the microvasculature.
Seema S Sinha; Michael X Pham; Randall H Vagelos; Mark G Perlroth; Sharon A Hunt; David P Lee; Hannah A Valantine; Alan C Yeung; William F Fearon
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  American heart journal     Volume:  155     ISSN:  1097-6744     ISO Abbreviation:  Am. Heart J.     Publication Date:  2008 May 
Date Detail:
Created Date:  2008-04-28     Completed Date:  2008-05-27     Revised Date:  2013-05-29    
Medline Journal Info:
Nlm Unique ID:  0370465     Medline TA:  Am Heart J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  889.e1-6     Citation Subset:  AIM; IM    
Department of Internal Medicine, Stanford University Medical Center, Stanford, CA 94305, USA.
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MeSH Terms
Coronary Artery Disease / drug therapy*
Coronary Vessels / drug effects*
Heart Transplantation*
Immunosuppressive Agents / pharmacology*
Middle Aged
Mycophenolic Acid / analogs & derivatives*,  pharmacology
Sirolimus / pharmacology*
Transplantation, Homologous
Treatment Outcome
Grant Support
1 K23 HL072808-01A1/HL/NHLBI NIH HHS; P01-AI50153/AI/NIAID NIH HHS
Reg. No./Substance:
0/Immunosuppressive Agents; 24280-93-1/Mycophenolic Acid; 53123-88-9/Sirolimus; 9242ECW6R0/mycophenolate mofetil

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