Abstract 20210: Optical Coherence Tomography Provides Insight Into Early Coronary Changes Related to Cardiac Allograft Vasculopathy in Pediatric Transplant Recipients
Introduction: Cardiac allograft vasculopathy (CAV) is a common cause of graft failure and mortality in pediatric heart transplant (Tx) recipients. CAV is diagnosed with coronary angiography which is unable to detect early coronary vascular changes that do not cause luminal narrowing.
Hypothesis: 1) Optical coherence tomography (OCT) can detect angiographically-silent coronary changes; 2) children with new CAV have more severe intimal thickening than those without CAV.
Methods: The International Pediatric OCT Registry includes 75 Tx recipients (age at Tx 4.6±4.3yrs) from centers in Canada and Europe. Patients underwent ≥1 assessment of ≥1 coronary artery using OCT (St Jude Medical) at cardiac catherization. We included cases with data from ≥10 cross-sectional images ≥1mm apart; we identified the maximal intimal thickness. CAV was classified by angiography according to the ISHLT criteria with investigators blinded to OCT findings. We used multi-level regression to assess between-group differences.
Results: We included 93 cases (age 11.8±4.0yrs at OCT; posttransplant time 7.6±4.6yrs; 54% male). In newly diagnosed CAV (all grade 1), maximal intimal thickness was significantly greater (median 0.31mm; IQR 0.22-0.56) compared to those without CAV (0.18mm; 0.12-0.23; p<0.001). In 12 cases, a change in medical management was made, typically related to immuno-suppressant therapy (e.g. 3 started sirolimus, 7 started steroid therapy). Of these cases, 10 were angiographically silent. Intimal thickness was greater in cases where medical management was changed compared with those where it was not changed (0.29mm; 0.18-0.38 vs. 0.18mm; 0.12-0.22; p<0.001). Serial assessments were done in 17 patients (time between OCT assessments 1.6±0.6yrs). Intimal thickness did not change significantly over time in those with or without CAV. One patient was diagnosed with CAV at the second OCT and had angiographically-silent severe intimal thickening at first OCT (0.43mm).
Conclusions: OCT can detect changes in intimal thickness that are angiographically silent. Children with a new diagnosis of CAV have more pronounced intimal thickening than those without CAV. These findings suggest that OCT findings may be useful in evaluating for CAV after heart transplantation.
Author Disclosures: K.C. Harris: None. S. Schubert: None. E. Balbacid: None. C. Voss: None. N. Lee: None. M.C. Hosking: None.
- © 2016 by American Heart Association, Inc.