Sirolimus as primary immunosuppression is associated with improved coronary vasomotor function compared with calcineurin inhibitors in stable cardiac transplant recipients

Eugenia Raichlin, Abhiram Prasad, Walter K. Kremers, Brooks S. Edwards, Charanjit S. Rihal, Amir Lerman, Sudhir S. Kushwaha

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

AimsThe 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 resultsEndothelium-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.ConclusionSirolimus 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.

Original languageEnglish (US)
Pages (from-to)1356-1363
Number of pages8
JournalEuropean Heart Journal
Volume30
Issue number11
DOIs
StatePublished - Jun 1 2009

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Sirolimus
Immunosuppression
Acetylcholine
Allografts
Nitroglycerin
Adenosine
Coronary Vessels
Spasm
Transplant Recipients
Calcineurin Inhibitors
Vasoconstriction
Cyclosporine
Endothelium
Blood Pressure

Keywords

  • Atherosclerosis
  • Blood flow
  • Endothelium
  • Sirolimus
  • Transplantation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Sirolimus as primary immunosuppression is associated with improved coronary vasomotor function compared with calcineurin inhibitors in stable cardiac transplant recipients. / Raichlin, Eugenia; Prasad, Abhiram; Kremers, Walter K.; Edwards, Brooks S.; Rihal, Charanjit S.; Lerman, Amir; Kushwaha, Sudhir S.

In: European Heart Journal, Vol. 30, No. 11, 01.06.2009, p. 1356-1363.

Research output: Contribution to journalArticle

Raichlin, Eugenia ; Prasad, Abhiram ; Kremers, Walter K. ; Edwards, Brooks S. ; Rihal, Charanjit S. ; Lerman, Amir ; Kushwaha, Sudhir S. / Sirolimus as primary immunosuppression is associated with improved coronary vasomotor function compared with calcineurin inhibitors in stable cardiac transplant recipients. In: European Heart Journal. 2009 ; Vol. 30, No. 11. pp. 1356-1363.
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T1 - Sirolimus as primary immunosuppression is associated with improved coronary vasomotor function compared with calcineurin inhibitors in stable cardiac transplant recipients

AU - Raichlin, Eugenia

AU - Prasad, Abhiram

AU - Kremers, Walter K.

AU - Edwards, Brooks S.

AU - Rihal, Charanjit S.

AU - Lerman, Amir

AU - Kushwaha, Sudhir S.

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N2 - AimsThe 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 resultsEndothelium-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.ConclusionSirolimus 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.

AB - AimsThe 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 resultsEndothelium-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.ConclusionSirolimus 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.

KW - Atherosclerosis

KW - Blood flow

KW - Endothelium

KW - Sirolimus

KW - Transplantation

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