Relationship between angiographic graft vessel disease and microvascular reaction after heart transplantation

Abstract

This study tests the correlation of coronary angiographic findings with the extent of microvascular reaction in right ventricular endomyocardial biopsies (EMBs) in transplanted hearts. In EMBs (n = 209) of 30 heart transplant patients (8 female, 22 male, mean age 48 years) microvascular reaction, i.e. endothelial cell swelling and vascular wall thickening (both grade 0-2), was graded by light microscopy at ×200. Patients' first and last coronary angiography (CA) (mean time after heart transplantation [HTx] 8 and 44 months) were graded according to the Stanford Classification and the presence of diameter irregularities was evaluated semi-quantitatively. We found a correlation of angiographic type B lesions with endothelial cell swelling during the first 5 months and vascular wall thickening during the fifth to fourteenth month after HTx (p <0.05). In patients with diameter irregularities and type B1 lesions in their first CA and type C lesions in their last CA, there was pronounced endothelial cell swelling in the early postoperative period (p <0.05). There was a tendency towards an increased vascular wall thickening in these patients during the later postoperative period. Graft vessel disease affects large and small coronary arteries and capillaries. Small vessel disease is characterized by architectural changes in blood vessel walls. Serial investigations of EMBs for diagnosis of small vessel disease complement the present diagnostic tools.