Abstract 13478: Chronological Differences in Cardiac Allograft Vasculopathy Assessed by Multivessel Optical Coherence Tomography
Background: Optical Coherence Tomography (OCT) provides details of coronary artery disease (CAD). We investigated whether OCT findings of cardiac allograft vasculopathy (CAV), a progressive disease, differ with follow-up duration.
Methods: OCT was conducted as part of routine catheterization after heart transplantation (HTx). A total 97 coronaries without prior percutaneous coronary intervension and stenosis ≥50% from 39 HTx patients (41 ± 14 years, 31 males) were divided by 4 chronological terms; control (8 weeks follow-up, n=16), early (1 year follow-up, n=23), mid (2-5 years follow-up, n=38) and late (6-16 years follow-up, n=24). OCT parameters were diagnosed according to CAD findings, i.e., lipid, calcium, and intraluminal thrombi. The findings included high intensity granules with acoustic shadow defined as macrophage accumulation. Intimal proliferation was defined as thickness ≥500μm, and angiogenesis was existence of micro-channels in contiguous frames within intima. Thin cap fibro atheroma (TCFA) was of cap thickness ≤70μm.
Results: Target vessel distribution (LAD/LCx/RCA) did not differ between the 4 groups (6/4/6 vs. 9/6/8 vs. 13/11/10 vs. 9/7/8, p=1.0). There was no ruptured plaque throughout the observation, but common features of CAD, such as increasing intimal thickening with lipid or calcium deposition, as well as macrophage accumulation and thrombus attachment increased with the follow-up duration (Table). Of note, intimal thickening and angiogenesis steeply increased at 1 year follow-up (vs. control, p<0.05). Twenty-two out of 26 (84.6%) angiogenesis were detected in eccentric intimal proliferation.
Conclusion: Pattern of CAV is similar to the CAD progression. Early introduction of OCT to follow-up after HTx may be useful to detect small disease progression, even though angiogram showed "normal".
- © 2013 by American Heart Association, Inc.