Progression of cardiac allograft vasculopathy assessed by serial three-vessel quantitative coronary angiography

Abstract

Background: The purpose of the present study was to assess the short- and long-term progression of cardiac allograft vasculopathy (CAV) using serial 3-vessel quantitative coronary angiography (QCA).

Methods: CAV progression was assessed using serial 3-vessel QCA analysis at baseline, 1-year and long-term angiographic follow-up (8.5±3.7 years) after heart transplantation. The change in minimal lumen diameter (MLD) and percent diameter stenosis (%DS) was serially assessed within matched segments. Patients were graded according to the ISHLT-CAV classification and grouped as ISHLT-CAV0 and ISHLT-CAV1-3. The primary endpoint was mean change in MLD and %DS.

Results: A total of 41 patients and 520 matched segments were available for serial 3-vessel QCA. Overall, MLD decreased non-significantly from baseline to 1-year follow-up and significantly from 1-year to the long-term angiographic follow-up (Δ-0.08mm/year [95%CI -0.11 to -0.05], P<0.001). %DS increased significantly from baseline to 1-year (Δ+0.96%/year [95%CI 0.04 to 1.88], P = 0.041) and from 1-year to long-term angiographic follow-up (Δ+0.61%/year [95%CI 0.33 to 0.88], P<0.001). ISHLT-CAV1-3 at 1 year and at long-term angiographic follow-up was observed in 22% and 61%, respectively. Between baseline and long-term angiographic follow-up, a significant reduction in MLD was observed within both groups without a significant difference in the reduction between the two groups (ISHLT-CAV0: median -0.49mm [IQR -0.54 to -0.43] vs. ISHLT-CAV1-3: median -0.40mm [IQR -0.44 to -0.35], P = 0.4).

Conclusion: The current data suggest that QCA can't predict CAV beyond 1 year, but, QCA affirmed that CAV progresses to a similar extent in patients who do not develop visual CAV during long-term follow-up.

Fig 1. Flow chart.

CAV indicates cardiac allograft vasculopathy; FUP, follow-up; QCA, quantitative coronary angiography; ISHLT, International Society of Heart and Lung Transplantation.

Fig 2. Serial 3-vessel quantitative coronary angiography analysis.

This figure shows the serial quantitative coronary angiography analysis within matched regions of all coronary artery segments at baseline, at 1 year follow-up, and at latest available angiographic follow-up. Coronary artery segments were classified according to the modified AHA/ACC classification. MLD indicates minimal lumen diameter; %DS, percent diameter stenosis.

Fig 3. Serial 3-vessel quantitative coronary angiography analysis.

Box-plot representation of minimal lumen diameter and maximal percent diameter stenosis at baseline (median 0.14 years [0.12 to 0.16], at 1 year (median 1.17 years [1.14 to 1.20]) and at long-term angiographic follow-up (median 8.61 years [8.24 to 8.99]) after HTx. Lower and upper box edges are the quartiles and thick line is the median.

Fig 4. Quantitative angiographic analysis.

Box-plot representation of the per-patient mean angiographic change in minimal lumen diameter (minimal lumen diameter 1 year—minimal lumen diameter baseline and minimal lumen diameter latest angiographic follow-up—minimal lumen diameter baseline) from coronary artery segments that were serially assessed and matched. The analysis is stratified according to absence (n = 16) or presence (n = 25) of ISHLT-CAV at 1 year, and at latest angiographic follow-up (median 8.61 years [8.24 to 8.99]). Lower and upper box edges are the quartiles and thick line is the median. A horizontal reference line at change = 0 is drawn.