Abstract 12707: Use of Optical Coherence Tomography For Characterization of Cardiac Allograft Vasculopathy
Background: Cardiac allograft vasculopathy (CAV) is the major limitation to long-term survival following cardiac transplantation and results in diffuse progressive coronary luminal narrowing. Optical coherence tomography (OCT) is a novel intracoronary imaging technique with a resolution 10 times greater than intravascular ultrasound. Our objective was to characterize CAV in-vivo using OCT to give further insight into the pathophysiology of CAV.
Methods: We prospectively enrolled 44 cardiac transplant patients to undergo OCT in addition to annual CAV screening by coronary angiography. OCT images were reviewed for specific CAV morphological characteristics within the framework of 4 groups according to follow-up time after heart transplantation: 1) 0 years (<3 months, n=5), 2) 1-2 years (n=14), 3) 3-5 years (n=6), 4) >5years (n=19).
Results: As outlined in the table and figure, the prevalence of eccentric plaque, thin-capped fibroatheroma, intimal laceration, plaque rupture as well as intraluminal and organized mural thrombus increased with time from heart transplantation. In patients with intraluminal thrombus (n=6), 1 (16.7%) had associated plaque rupture and 5 (83.3%) had intimal laceration.
Conclusions: OCT reveals CAV disease aspects that extend far beyond the current concept of concentric and fibrosing vasculopathy. Unstable coronary pathology including intimal laceration, plaque rupture and intraluminal thrombus was clearly observed in asymptomatic cardiac transplant recipients. Furthermore, organized mural thrombus was highly prevalent and possibly a significant factor in CAV progression and eccentric disease.
- © 2012 by American Heart Association, Inc.