Abnormalities in intramyocardial arteries detected in cardiac transplant biopsy specimens and lack of correlation with abnormal intracoronary ultrasound or XXXX in large epicardial coronary arteries.

@entity1 @entity455 @entity66 @entity6249 @entity39 @entity5 @entity409 @entity934
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 @entity409 in large epicardial vessels. BACKGROUND: Variability in clinical presentation of allograft vasculopathy suggests differential involvement of large and small vessels. Intracoronary 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 @entity934 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, @entity5 @entity39 factor-alpha and receptor for hyaluronan-mediated motility. @entity66 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 @entity934 challenge. RESULTS: Coronary arteries were found in the biopsy tissue of 30 (76%) of the 39 @entity1 who formed the study group. Fourteen of 30 @entity1 had abnormal histologic findings. Immunohistochemical analysis for fibronectin, possible in 20 of 30 @entity1 , was positive in 14 (70%) of 20 and correlated with abnormal histologic findings (p = 0.01). Immunostaining was positive for @entity5 @entity39 factor-alpha and receptor for hyaluronan-mediated motility in 12 (40%) and 13 (43%) of 30 @entity1 , respectively. All @entity1 had intimal thickening by intracoronary ultrasound, but intimal index did not correlate significantly with @entity455 by histologic or immunohistochemical analysis. @entity409 in 13 @entity1 (43%) did not correlate with either abnormal ultrasound findings or @entity6249 . CONCLUSIONS: Intramyocardial arteries are readily observed in biopsy specimens from cardiac transplant recipients and provide useful information about allograft vasculopathy. Lack of correlation between @entity66 suggests discordant progression of allograft vasculopathy.
