Abstract 11473: Optical Coherence Tomography and Intravascular Ultrasound Evaluation of Cardiac Allograft Vasculopathy With and Without Intimal Angiogenesis
Background: Intraplaque micro-channel (MC) is believed to contribute to plaque progression as angiogenesis, however it is not well known in cardiac allograft vasculopathy (CAV).
Methods: At routine annual angiography, 39 heart transplant (HTx) patients underwent both intravascular ultrasound (IVUS) and optical coherence tomography (OCT) for assessing CAV in 97 coronaries. OCT analysis focused on qualitative analysis, such as intimal proliferation/distribution, ruptured appearance, MC and macrophage accumulation. MC was defined as tubule-luminal structures in multiple contiguous frames. High intensity signal with attenuation was recorded as macrophages. Vessel, lumen and intimal volume were measured by motorized pullback (0.5 mm/s) of 40-MHz IVUS images. Volume index was defined as volume/length (mm3/mm). Intimal burden (%) was calculated by (intima/vessel volume) х 100.
Results: Mean duration from HTx to examination was 4.3 years (range 0-16) and 31 patients were male. Seventeen HTx patients (43.6%) had MC. Mean MC number per vessel was 4.8 (range 1-15) and the maximum diameter was 109 ± 68 μm. There was no ruptured appearance. The differences between vessels with/without MC are shown in Table. There were no differences in patient backgrounds, such as history of rejection ≥ISHLT-3A, cytomegalovirus infection, high-sensitivity troponin T, C-reactive protein, or coronary risk factors except higher LDL-cholesterol (91 ± 27 vs. 75 ± 24 mg/dl, p=0.010) in patients with MC. Majority of MC (84.6%) were in eccentric intima and the thickening was greater than that of non MC (1054 ± 269 vs. 691 ± 403 μm, p<0.001). MC number presented positive correlation with intimal volume index (r=0.6, p=0.003).
Conclusion: Intimal proliferation, i.e., intimal thickness and volume was associated with MC. Presence of MC may be affected by recipient environment rather than transmission.
- © 2013 by American Heart Association, Inc.