Virtual Histology Intravascular Ultrasound Assessment of Cardiac Allograft Vasculopathy From 1 to 20 Years After Heart Transplantation

• Published in: The Journal of heart and lung transplantation Vol. 28; no. 2; pp. 156 - 162
• Main Authors: de la Torre Hernandez, Jose M., MD, PhD, Vazquez de Prada, Jose A., MD, PhD, Burgos, Virginia, MD, Sainz Laso, Fermin, MD, Fernandez Valls, Monica, MD, Gonzalez Vilchez, Francisco, MD, PhD, Llano, Miguel, MD, Ruano, Javier, MD, Zueco, Javier, MD, Colman, Thierry, MD, Martín Duran, Rafael, MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-02-2009; Elsevier
• Subjects: Aged; Arterial Occlusive Diseases - diagnostic imaging; Arterial Occlusive Diseases - pathology; Biological and medical sciences; Cardiology. Vascular system; Cardiovascular Diseases - diagnostic imaging; Cardiovascular Diseases - pathology; Coronary Angiography; Echocardiography - methods; Female; Follow-Up Studies; Heart Diseases - classification; Heart Diseases - complications; Heart Diseases - surgery; Heart Transplantation - adverse effects; Heart Transplantation - pathology; Humans; Male; Medical sciences; Middle Aged; Regression Analysis; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Time Factors; Tissue Donors - statistics & numerical data; User-Computer Interface; Heart; Sonography; Cardiovascular disease; Transplantation; Histology; Homotransplantation; Phlebology; Vascular disease; Treatment; Surgery; Graft; Circulatory system; Cardiology; Ultrasound
• ISSN: 1053-2498; 1557-3117
• DOI: 10.1016/j.healun.2008.11.915

Background Cardiac allograft vasculopathy (CAV) is the main cause of graft loss and death in heart transplant (HTx) recipients surviving >1 year. There is a dual etiology for coronary disease in HTx: classic atherosclerosis and an immunologically mediated disease. Intravascular ultrasound (IVUS) is highly sensitive for CAV detection; however, gray-scale IVUS is of limited value for identification of specific plaque components. We sought to characterize graft coronary artery disease by means of IVUS–virtual histology (IVUS-VH) at different time-points of follow-up and to correlate plaque composition with clinical factors. Methods In our study we included 67 patients, who were 7.6 ± 5.7 years post-HTx. IVUS gray-scale evaluation was performed on all patients. IVUS-VH analysis was done in those patients showing intimal thickening >0.5 mm at the three more significant lesions (three cross-sections for each) of the left anterior descending artery. Results IVUS-VH analysis was obtained done on 58 patients (86.5%). We found a significant correlation between time of HTx and IVUS gray-scale parameters (plaque area and plaque burden), with both increasing over time. We also found a significant correlation between time and IVUS-VH–derived plaque components, necrotic core and calcium, which increased with time, and fibrous and fibrofatty components, both decreased at follow-up. IVUS-VH results were also related to donor age and cardiovascular risk factors. Conclusions We observed a time-related change in IVUS-VH–derived plaque composition. Necrotic core and calcium, typical atheromatous components, become more prevalent with time after HTx, especially when influenced by cardiovascular risk factors. The presence of a necrotic core in the early stages was linked to older donor age.