| Sirolimus as primary immunosuppression is associated with improved coronary vasomotor function compared with calcineurin inhibitors in stable cardiac transplant recipients. | |
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MedLine Citation:
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PMID: 19383734 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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AIMS: The aim of this study was to evaluate coronary vasomotor function in cardiac transplant recipients maintained on sirolimus (SRL)- or cyclosporin (CyA)-based immunosuppression. METHODS AND RESULTS: Endothelium-independent response to intracoronary nitroglycerin and adenosine and endothelium-dependent response to intracoronary acetylcholine (Ach) were assessed in 15 SRL- and 21 CyA- treated subjects with angiographically normal coronary arteries. Baseline mean blood pressure was lower in the SRL group (85.6 +/- 10.3 vs. 105.2 +/- 8.7 mmHg, P = 0.002). There was no difference between the groups in coronary flow reserve after adenosine administration in multivariable analysis (P = 0.34). Nitroglycerin administration resulted in increase in coronary artery diameter in the SRL compared with the CyA groups (2.79 +/- 0.54 vs. 2.57 +/- 0.61, P = 0.0036). In 13 SRL-treated subjects without evidence of cardiac allograft vasculopathy (CAV), Ach administration resulted in less epicardial vasoconstriction compared with CyA-treated subjects (2.7 +/- 17.7 vs. -15.6 +/- 17.2%, P = 0.005). Two SRL-treated subjects with three-dimensional intravascular ultrasound evidence of CAV developed coronary spasm in response to Ach 10(-4). Microvascular endothelial function did not differ between the groups. CONCLUSION: Sirolimus immunosuppression is associated with less pronounced coronary epicardial endothelial dysfunction compared with CyA immunosuppression. Improvement of coronary vasomotor function with SRL may be an important mechanism for the prevention of CAV. |
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Authors:
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Eugenia Raichlin; Abhiram Prasad; Walter K Kremers; Brooks S Edwards; Charanjit S Rihal; Amir Lerman; Sudhir S Kushwaha |
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Publication Detail:
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Type: Comparative Study; Journal Article; Research Support, Non-U.S. Gov't Date: 2009-04-21 |
Journal Detail:
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Title: European heart journal Volume: 30 ISSN: 1522-9645 ISO Abbreviation: Eur. Heart J. Publication Date: 2009 Jun |
Date Detail:
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Created Date: 2009-06-02 Completed Date: 2009-07-27 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8006263 Medline TA: Eur Heart J Country: England |
Other Details:
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Languages: eng Pagination: 1356-63 Citation Subset: IM |
Affiliation:
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William J. von Liebig Transplant Center and the Division of Cardiovascular Diseases, Mayo Clinic (Go 5-469), 200 First Street, SW, Rochester, MN 55905, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Calcineurin / therapeutic use* Coronary Circulation / drug effects Endothelium, Vascular / drug effects*, physiopathology Female Graft Rejection / prevention & control Heart Transplantation* Humans Immunosuppressive Agents / therapeutic use* Male Middle Aged Prognosis Sirolimus / therapeutic use* Vasomotor System / drug effects*, physiology |
| Chemical | |
Reg. No./Substance:
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0/CABIN1 protein, human; 0/Immunosuppressive Agents; 53123-88-9/Sirolimus; EC 3.1.3.16/Calcineurin |
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