Plaque regression associated with everolimus administration after heart transplantation

Abstract

A 45-year-old male who had suffered from refractory non-ischemic heart failure treated with a left ventricular assist device received heart transplantation in February 2008. He underwent coronary angiography (CAG) and intravascular ultrasound (IVUS) at 3 months, and 1, 2, and 3 years after surgery. At 3 months, neither significant stenosis on CAG nor plaque on 3 coronary arteries, as assessed by IVUS were observed. However, focal eccentric plaque on proximal left anterior descending artery has developed up to 2 years, despite the fact that risk factors for cardiac allograft vasculopathy were well controlled. At 2 years, everolimus 2.5. mg/day was added to the patient's existing regimen consisting of corticosteroids, mycophenolate mofetil, and cyclosporine. Then mycophenolate mofetil was withdrawn. At 3 years, concomitant with plaque regression, a decreased plaque volume index, enlarged lumen volume index, and increased minimum lumen area were observed. We experienced a case with plaque regression associated with everolimus administration. Further investigations are needed to explore the mechanism of plaque regression associated with everolimus, as well as to confirm our observation in randomized controlled trials for patients after heart transplantation.