Abstract 15075: Differing Prevalence of Pediatric Coronary Allograft Vasculopathy Between Single Centres in North America and Europe: A Prospective IVUS Study
Background: Coronary allograft vasculopathy (CAV) is the leading cause of death after pediatric heart transplantation from 1 year postoperatively. Anecdotal evidence suggests a difference in the severity of disease between UK and North America. We performed a comparative study using intravascular ultrasound (IVUS).
Methods: All IVUS procedures performed in 2012 were included prospectively. IVUS images were analysed by a single operator in each centre using an identical method. After standard image acquisition each study is analysed using QIVUS® (Medis Imaging, NL) to provide semi-automatic image analysis at every third cardiac cycle. Detailed measurement of the vessel area (VA), lumen area (LA), maximal intima-medial thickening (IMT) is performed with subsequent calculation of intimal index (II) (VA-LA/VA) for each slice. Mean II and mean IMT and absolute maximum IMT is calculated along the length of the LAD coronary artery for each patient. Transplant demographics are included.
102 patients were included between the two centres. Table 1 demonstrates the key differences between the groups. Interobserver variability was excellent (Intra-class correlation coefficient >0.9)
Conclusions: In these 2 cohorts of similar ages there is a clear difference in CAV with significantly more disease in the European cohort despite significantly shorter time post transplant. The causes are likely to be multifactorial, but this work confirms registry data of the increased risk of pediatric CAV with older donors and recipients. However, the changes seen on IVUS are more obvious and earlier than would be expected from registry information derived from angiography alone.
- © 2013 by American Heart Association, Inc.