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. 2023 Dec 6:3:100038.
doi: 10.1016/j.jhlto.2023.100038. eCollection 2024 Feb.

Cardiac allograft vasculopathy in heart transplanted recipients: The multivessel study

Niels Møller Jensen  1   2 , Tor Skibsted Clemmensen  1 , Kamilla Pernille Bjerre  1   2 , Omeed Neghabat  1   2 , Lone Juul Hune Mogensen  1 , Niels Ramsing Holm  1 , Jouke Dijkstra  3 , Evald Høj Christiansen  1   2 , Steen Hvitfeldt Poulsen  1   2 , Hans Eiskjær  1   2
Affiliations

Cardiac allograft vasculopathy in heart transplanted recipients: The multivessel study

Niels Møller Jensen et al. JHLT Open. .

Abstract

Background: Cardiac allograft vasculopathy (CAV) is a prevailing complication following heart transplantation. We aimed to investigate if CAV causes equal vascular remodeling in the major coronary arteries using quantitative optical coherence tomography (OCT) and to explore the prognostic potential of OCT-derived measurements from each coronary artery.

Methods: Sixty-four heart transplanted patients had a combined total of 114 full 3-vessel OCTs and coronary angiographies performed between 2013 and 2019. OCT pullbacks were categorized by angiographic CAV classification. Registration of disease progression was censored on July 1, 2022.

Results: OCT recordings were classified as follows: no significant CAV, n = 73; mild CAV, n = 18; moderate CAV, n = 13; and severe CAV, n = 10. From intercoronary comparison of severe CAV, we found significant differences by both average lumen/intima ratio (p < 0.0001) and average intima/media ratio (p < 0.0001). The left descending artery (LAD) showed increasingly smaller luminal areas and larger intimal areas within CAV groups compared with the remaining coronary arteries. No differences were seen between major coronary arteries without significant CAV. LAD derived average intima/media ratio (hazard ratio (HR): 3.39; 95% confidence interval (CI): 1.33-8.63; p = 0.01) and average lumen/intima ratio (HR: 2.77; 95% CI: 1.09-7.05; p = 0.03) were the strongest predictors of CAV progression.LAD predictions were superior to predictions based on all 3 coronary arteries.

Conclusions: LAD-derived OCT measurements were increasingly affected by CAV compared with the circumflex and right coronary artery. Average lumen/intima and intima/media ratios were the strongest predictors of CAV progression.

Keywords: cardiac allograft vasculopathy; coronary artery; heart transplantation; intravascular imaging; optical coherence tomography.

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Figures

Figure 1
Figure 1
Quantitative optical coherence tomographic vessel layer analysis. (A) No significant cardiac allograft vasculopathy; (A′) vessel layer analysis; (B) severe cardiac allograft vasculopathy; (B′) vessel layer analysis. Red ring and arrow mark lumen-intima interface; pink ring and arrow mark intima-media interface; green ring and arrow mark media-adventitia interface.
Figure 2
Figure 2
Between-vessel differences in vessel layers using optical coherence tomography. (A) Margin plots with mean and 95% confidence intervals (CI) demonstrating differences between vessels for average intima area (IA), average lumen area (LA), and minimum lumen area (MLA); (B) margin plots with mean and 95% CI demonstrating differences between vessels by cardiac allograft vasculopathy (CAV) for average lumen/intima ratio (L/I) and average intima/media ratio (I/M).
Figure 3
Figure 3
Prognostic value of OCT measurements from each coronary artery. Kaplan-Meier curves and hazard ratios (HR) for prediction of cardiac allograft vasculopathy (CAV) progression by optical coherence tomography (OCT) measurements derived from each coronary vessel. (A) Average intima area (IA); (B) average lumen/intima ratio (L/I); (C) average intima/media ratio (I/M).
Figure 4
Figure 4
Prognostic value of OCT measurements: LAD vs combined vessels. Kaplan-Meier curves and hazard ratios (HR) for prediction of cardiac allograft vasculopathy (CAV) progression comparing LAD to the corresponding combined average coronary vessel measurements (combined). IA, intima area; L/I, lumen/intima ratio; I/M, intima/media ratio.
See this image and copyright information in PMC

References

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