An Improvement in Peripheral Endothelial Function Six Months after Heart Transplantation Is Associated with a Lower Incidence of Coronary Allograft Vasculopathy

Purpose Peripheral endothelial dysfunction has been associated with the development of coronary disease in the general population. Its relationship with the development of coronary allograft vasculopathy (CAV) after heart transplantation has not been established. Our aim was to determine if the evolution of peripheral endothelial function is related to the development of CAV. Methods and Materials Forty-two patients who received a heart transplantion in a single institution between 2001 and 2004 were prospectively studied. Plasmatic endothelin levels and peripheral endothelial function (flow mediated dilatation assessed by vascular ultrasound of the brachial artery) were determined at month 1 and 6 after transplantation. The development of CAV was monitored with anual angiograms. The primary endpoint was defined as the composite of CAV grade ≥2 according to the ISHLT nomenclature (>50% left main disease or ≥70% in one or more primary vessels) or death related to CAV (sudden death in a patient with known CAV and correct immunosupresion levels). Results Mean follow-up was 3131 ±908 days. At first month post-transplantation, recipients who did not present the primary endpoint showed an impaired flow- mediated dilatation compared to recipients who presented CAV (1,67%±2 vs. 4,32%±3,3, p=0,007) and higher endotheline levels (8,88±0,8 vs. 6,28±1,6, p=0,023). In contrast, recipients who did not present the primary endpoint showed a significant improvement in their endothelial function at 6 months post-transplantation, compared to recipients with CAV (1,65% ±3,1 vs. −1,4% ±2,5, p=0.019). Conclusions Recipients with no CAV showed an improvement in their endothelial function six months after heart transplantation, compared to recipients with significant CAV. The evolution of peripheral endothelial function in the early post- transplantation period could be a predictor for the development of CAV.