Author + information
- Received November 29, 1994
- Revision received February 16, 1995
- Accepted February 27, 1995
- Published online July 1, 1995.
- Nadine Clausell, MD, PhDa,b,
- Jagdish Butany, MDa,b,
- Silvana Molossi, MD, PhDa,b,
- Eva Lonn, MDa,b,
- Peter Gladstone, MDa,b,
- Marlene Rabinovitch, MD, FACCa,b and
- Paul A. Daly, MDa,b,*
- ↵*Address for correspondence: Dr. Paul A. Daly. The Toronto Hospital, 200 Elizabeth Street, 3 EN-224, Toronto. Ontario. Canada.
Objectives. We sought to determine whether abnormalities in small intramyocardial vessels could be detected on routine cardiac transplant biopsy specimens and whether these features correlate with intimal thickening by intracoronary ultrasound and endothelial dysfunction in large epicardial vessels.
Background. Variability in clinical presentation of allograft vasculopathy suggests differential involvement of large and small vessels. Intracoronarv ultrasound and endothelial function studies detect large-vessel abnormalities but may not reflect changes in small intramyocardial arteries. The latter could be detected in routine cardiac biopsy specimens by histologic and immunohistochemical studies.
Methods. Thirty-nine cardiac transplant recipients underwent intracoronary ultrasound and acetylcholine studies 5 to 7 days after endomyocardial biopsy. Biopsy tissue was evaluated for coronary artery endothelial plumping and intimal thickening and increased immunostaining for fibronectin, tumor necrosis factor-alpha and receptor for hyaluronan-mediated motility. Large-vessel disease was assessed by calculating an average intimal index from intracoronary ultrasound of the left anterior descending coronary artery. Endothelial function was determined by quantitative coronary analysis after acetylcholine challenge.
Results. Coronary arteries were found in the biopsy tissue of 30 (76%) of the 39 patients who formed the study group. Fourteen of 30 patients had abnormal histologic findings. Immunohistochemical analysis for fibronectin, possible in 20 of 30 patients, was positive in 14 (70%) of 20 and correlated with abnormal histologic findings (p = 0.01). Immunostaining was positive for tumor necrosis factor-alpha and receptor for hyaluronan-mediated motility in 12 (40%) and 13 (43%) of 30 patients, respectively. All patients had intimal thickening by intracoronary ultrasound, but intimal index did not correlate significantly with small-artery disease by histologic or immunohistochemical analysis. Large-vessel endothelial dysfunction in 13 patients (43%) did not correlate with either abnormal ultrasound findings or small-vessel disease.
Conclusions. Intramyocardial arteries are readily observed in biopsy specimens from cardiac transplant recipients and provide useful information about allograft vasculopathy. Lack of correlation between intramyocardial and epicardial vessel disease suggests discordant progression of allograft vasculopathy.
This study was supported by an operational grant from Searle Pharmaceuticals, Canada to Dr. Daly. Drs. Clausell and Molossi are fellows and Dr. Rabinovitch a Career Investigator of the Heart and Stroke Foundation of Ontario, Toronto.
- Received November 29, 1994.
- Revision received February 16, 1995.
- Accepted February 27, 1995.
- The American College of Cardiology