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. 2021 Apr 1:328:227-234.
doi: 10.1016/j.ijcard.2020.12.025. Epub 2020 Dec 11.

Cardiac allograft vasculopathy: Differences of absolute and relative intimal hyperplasia in children versus adults in optical coherence tomography

Madeleine Orban  1 , Sarah Ulrich  2 , Dominic Dischl  3 , Patrick von Samson-Himmelstjerna  4 , René Schramm  4 , Katharina Tippmann  3 , Ralph Hein-Rothweiler  3 , Anna Strüven  3 , Anja Lehner  2 , Daniel Braun  3 , Jörg Hausleiter  5 , Andre Jakob  2 , Marcus Fischer  2 , Christian Hagl  6 , Nikolaus Haas  2 , Steffen Massberg  5 , Julinda Mehilli  5 , Dalla Pozza Robert  2
Affiliations

Cardiac allograft vasculopathy: Differences of absolute and relative intimal hyperplasia in children versus adults in optical coherence tomography

Madeleine Orban et al. Int J Cardiol. .

Abstract

Background: Intracoronary imaging enables an early detection of intimal changes. To what extend the development of absolute and relative intimal hyperplasia in intracoronary imaging differs depending on age and post-transplant time is not known.

Methods: Aim of our retrospective study was to compare findings between 24 pediatric (cohort P) and 21 adult HTx patients (cohort A) using optical coherence tomography (OCT) at corresponding post-transplant intervals (≤5 years: P1 (n = 11) and A1 (n = 10); >5 and ≤ 10 years: P2 (n = 13) and A2 (n = 11),. Coronary intima thickness (IT), media thickness (MT) and intima to media ratio (I/M) were assessed per quadrant. Maximal IT >0.3 mm was considered absolute, I/M > 1 relative intimal hyperplasia.

Results: Compared to A1, I/M was significantly higher in P1 (maximal I/M: P1: 5.41 [2.81-13.39] vs. A1: 2.30 [1.55-3.62], p = 0.005), whereas absolute IT values were comparable. In contrast, I/M was comparable between P2 and A2, but absolute IT were significantly higher in A2 (maximal IT: P2: 0.16 mm [0.11-0.25] vs. A2: 0.40 mm [0.30-0.71], p < 0.001). A2 presented with higher absolute IT (maximal: A1: 0.16 mm [0.12-0.44] vs. A2: 0.40 mm [0.30-0.71], p = 0.02) and I/M (maximal I/M A1: 2.30 [1.55-3.62] vs. A2: 3.79 [3.01-5.62], p = 0.04).

Conclusion: Our results suggest an age- and time-dependent difference in the prevalence of absolute and relative intimal hyperplasia in OCT, with an early peak in children and a progressive increase in adults.

Keywords: Absolute intimal hyperplasia; Adult heart transplantation; Optical coherence tomography; Pediatric heart transplantation; Relative intimal hyperplasia.

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Conflict of interest statement

Declaration of competing interest Dr. S. Ulrich used retrospectively some OCT data that had also been previously used in a prospective study supported by Novartis Pharma GmbH. Novartis Pharma GmbH was not involved in the development, realization and data analysis of this study. Dr. S. Ulrich has also received financial research support from Astellas Pharma GmbH, “Verein zur Förderung von Wissenschaft und Forschung“(medical faculty of Ludwig-Maximilians-University Munich, Germany) and currently receives financial research support from Gerd-Killian Projektförderung (DGPK, “Deutsche Herzstiftung”, Germany). Dr. Braun reports speaker honoraria from Abbott Vascular. Dr. Hausleiter reports grants and personal fees from Abbott Vascular, grants and personal fees from Edwards Lifesciences, outside the submitted work. Dr. Massberg reports grants from German Federal Ministry of Education and Research (BMBF)/German Center for Cardiovascular Research (DZHK), grants from German Research Foundation (DFG), grants from Boston scientific, grants from Foundation Leduq Transatlantic Network of Excellence, outside the submitted work. Dr. Mehilli received funding of German Centre for Cardiovascular Research (DZHK) for material costs of optical coherence tomography and image analysis. The authors report no relationships that could be construed as a conflict of interest.

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