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. 2021 Dec 23;8(1):e1266.
doi: 10.1097/TXD.0000000000001266. eCollection 2022 Jan.

Analysis of Fibrotic Plaques in Angiographic Manifest Cardiac Allograft Vasculopathy in Long-term Heart Transplanted Patients Using Optical Coherence Tomography

Affiliations

Analysis of Fibrotic Plaques in Angiographic Manifest Cardiac Allograft Vasculopathy in Long-term Heart Transplanted Patients Using Optical Coherence Tomography

Madeleine Orban et al. Transplant Direct. .

Abstract

Background: The development and progression of cardiac allograft vasculopathy documented by coronary angiography (CAVangio) after heart transplantation (HTx) has prognostic relevance. Yet there are limited data regarding the role of concomitant intracoronary imaging in the presence CAVangio. In particular, atherosclerotic plaques might represent a potential target for prevention, but their impact on stenosis is understudied.

Methods: We used high-resolution intracoronary optical coherence tomography (OCT) to quantify and compare findings of intimal hyperplasia (IH) and plaque morphologies in HTx patients (fibrotic plaque, lipid plaque, and calcified plaque). OCT findings were related to the presence of CAVangio as well as to the severity of stenosis.

Results: We included 65 consecutive patients into analysis (66% with CAVangio, posttransplant interval 9.9 ± 7.6 y). Fibrotic, lipid, and calcified plaques were present in 41 (63.1%), 39 (60%), and 18 (27.7%) patients, respectively. In addition to IH, the presence of fibrotic, lipid, and calcified plaques was found to be associated with CAVangio. The prevalence of lipid plaque and quantitative measurements of fibrotic plaque increased with stenosis severity (lipid plaque, P < 0.001, maximal and mean fibrotic arc, P = 0.05 and P = 0.001, respectively). Receiver operating characteristic analysis showed that area under the curve of the fibrotic plaque parameter mean fibrotic arc (0.87, 95% confidence interval [0.76-0.99]; P = 0.002) was superior to area under the curve of intima parameters regarding CAVangio. The effect of mean fibrotic arc (r = 0.52, P < 0.001) was relevant regarding stenosis severity.

Conclusions: After a longer posttransplant interval, CAV findings in OCT included a combination of IH and atherosclerotic plaques. In addition to IH, the presence of fibrotic, lipid, and calcified plaques is associated with CAVangio. Further studies are warranted to evaluate if the in vivo screening for plaque progress, particularly of fibrotic plaque, could improve individual secondary prevention and outcome in HTx patients.

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Conflict of interest statement

S.U. reports grants from Novartis Pharma GmbH and Astellas Pharma GmbH, outside the submitted work. M.W.O. received speaker honoraria from Abbott Medical, AstraZeneca, Abiomed, Bayer vital, BIOTRONIK, Bristol Myers Squibb, CytoSorbents, Daiichi Sankyo Deutschland, Edwards Lifesciences Services, Sedana Medical, outside the submitted work. D.B. reports speaker honoraria from Abbott Vascular, outside the submitted work. J.H. reports grants and personal fees from Abbott Vascular, grants and personal fees from Edwards Lifesciences, outside the submitted work. J.M. reports grants and personal fees from Boston Scientifics, Astra Zeneca, Bristol Myers Squibb, Edward Life Science, outside the submitted work. S.M. reports grants from German Federal Ministry of Education and Research (BMBF)/German Centre 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. The other authors declare no conflicts of interest.

Figures

FIGURE 1.
FIGURE 1.
Representative optical coherence tomography (OCT) findings. A, Example of eccentric intimal hyperplasia. The blue line represents the intima measurement; the red line represents the media measurement in one quadrant. B, Circular calcified plaque. C, Lipid plaque. D, Fibrotic plaque. Border between lateral plaque borders and normal vessel wall are delineated and thereby the arc of the plaque is measured.
FIGURE 2.
FIGURE 2.
Optical coherence tomography (OCT) findings in patients with and without angiographic manifest cardiac allograft vasculopathy (CAVangio). Patients without CAVangio, n = 22. Patients with CAVangio, n = 43. A, Prevalence of absolute and relative CAVIH. Maximal intimal thickness (IT) >0.3 mm denotes absolute CAVIH. Maximal intima-media ratio (I/M) >3 denotes relative CAVIH with a cutoff of I/M >3. B, Prevalence of fibrotic, lipid, and calcified plaques. CAVangio was defined according to the classification of the International Society for Heart and Lung Transplantation (ISHLT) as ISHLT CAV grade >0 in the analyzed vessel. P values are shown for χ2 test.
FIGURE 3.
FIGURE 3.
Receiver operating characteristic curves of relevant optical coherence tomography (OCT) parameters contributing to the presence of angiographic manifest cardiac allograft vasculopathy (CAVangio). AUC, area under the curve; CI, confidence interval; I/M, intima-media ratio; IT, intimal thickness.

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