1
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Shah H, Lee I, Rao S, Suddath W, Rodrigo M, Mohammed S, Molina E, García-Garcia HM, Kenigsberg BB. Quantitative flow ratio computed from invasive coronary angiography as a predictor for cardiac allograft vasculopathy after cardiac transplant. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2024; 40:451-458. [PMID: 38117378 DOI: 10.1007/s10554-023-03012-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 11/16/2023] [Indexed: 12/21/2023]
Abstract
Cardiac allograft vasculopathy (CAV) is a significant determinant of long-term survival in heart transplant recipients. Standard CAV screening typically utilizes invasive coronary angiography (ICA). Quantitative flow ratio (QFR) is a computational method for functional testing of coronary stenosis, and may add diagnostic value to ICA in assessing CAV. Consecutive subjects who received heart transplantation and underwent two separate routine coronary angiograms between January 2013 and April 2016 were enrolled. Coronary angiograms and IVUS were performed per local protocol at 1, 2, 3 and 5 years post-transplant. QFR was calculated offline. CAV was assessed semi-quantitively based on coronary angiogram results. Twenty-two patients were enrolled. Mean time from transplant to first included ICA was 2.1 years. QFR in at least 1 coronary vessel was interpretable in 19/22 (86%) of initial ICA (QFR1). QFR1 correlated well with the CAV score derived from the second ICA (CAV2) with a clustering of CAV at lower QFR values. In a receiver-operating characteristic (ROC) analysis, an optimal QFR threshold of 0.88 yielded 0.94 sensitivity and 0.67 specificity (AUC of 0.79) for at least non-obstructive subsequent CAV. Initial angiographically and intravascular ultrasound derived CAV severity poorly predicted subsequent CAV severity. QFR derived from invasive coronary angiography predicts subsequent development of CAV more accurately than angiography and intravascular ultrasound. This novel method of coronary flow assessment in recipients of heart transplantation may be useful to diagnose and predict subsequent CAV development.
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Affiliation(s)
- Harsh Shah
- Department of Cardiology, Jefferson Einstein Hospital, Philadelphia, PA, USA
| | - Injoon Lee
- Department of Medicine, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Sriram Rao
- Department of Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - William Suddath
- Department of Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Maria Rodrigo
- Department of Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Selma Mohammed
- Department of Cardiology, Creighton University School of Medicine, Omaha, NE, USA
| | - Ezequiel Molina
- Department of Cardiac Surgery, Piedmont Heart Institute, Atlanta, GA, USA
| | - Hector M García-Garcia
- MedStar Cardiovascular Research Network, MedStar Washington Hospital Center, Washington, DC, USA
| | - Benjamin B Kenigsberg
- Department of Cardiology, MedStar Washington Hospital Center, Washington, DC, USA.
- Department of Critical Care, MedStar Washington Hospital Center, 110 Irving St., NW, Rm A121, Washington, DC, 20010, USA.
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2
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Shahandeh N, Parikh RV. Invasive Intracoronary Imaging of Cardiac Allograft Vasculopathy: Established Modalities and Emerging Technologies. Interv Cardiol Clin 2023; 12:269-280. [PMID: 36922067 DOI: 10.1016/j.iccl.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
Despite advances in the care of heart transplant recipients during the past 5 decades, cardiac allograft vasculopathy (CAV) continues to be a major barrier to long-term survival. The early diagnosis and treatment of CAV is crucial for improving long-term outcomes. Coronary angiography, the current gold standard for CAV screening, has low sensitivity for detecting early CAV. Increasingly, invasive intracoronary imaging modalities that provide a more detailed analysis of vessel anatomy and allow for plaque characterization are being used to detect CAV earlier after transplant and uncover mechanistic insights. Studies validating these emerging imaging platforms are needed before their widespread adoption.
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Affiliation(s)
- Negeen Shahandeh
- Division of Cardiology, University of California, 100 Medical Plaza, Suite 630 East, Los Angeles, CA 90095, USA
| | - Rushi V Parikh
- Division of Cardiology, University of California, Los Angeles, 100 Medical Plaza, Suite 630 West, Los Angeles, CA 90095, USA.
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3
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Jensen NM, Chen Z, Clemmensen TS, Neghabat O, Holck EN, Pazdernik M, Mogensen LJH, Wahle A, Sonka M, Eiskjær H. Validation of a semi-automatic software for optical coherence tomography - analysis in heart transplanted patients. Int J Cardiovasc Imaging 2023; 39:257-268. [PMID: 36109445 PMCID: PMC10519345 DOI: 10.1007/s10554-022-02722-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 08/23/2022] [Indexed: 01/26/2023]
Abstract
Optical Coherence Tomography (OCT) is an intravascular imaging modality enabling detailed evaluation of cardiac allograft vasculopathy (CAV) after heart transplantation (HTx). However, its clinical application remains hampered by time-consuming manual quantitative analysis. We aimed to validate a semi-automated quantitative OCT analysis software (Iowa Coronary Wall Analyzer, ICWA-OCT) to improve OCT-analysis in HTx patients. 23 patients underwent OCT evaluation of all three major coronary arteries at 3 months (3M) and 12 months (12M) after HTx. We analyzed OCT recordings using the semiautomatic software and compared results with measurements from a validated manual software. For semi-automated analysis, 31,228 frames from 114 vessels were available. The validation was based on a subset of 4287 matched frames. We applied mixed model statistics to accommodate the multilevel data structure with method as a fixed effect. Lumen (minimum, mean, maximum) and media (mean, maximum) metrics showed no significant differences. Mean and maximum intima area were underestimated by the semi-automated method (β-methodmean = - 0.289 mm2, p < 0.01; β-methodmax = - 0.695 mm2, p < 0.01). Bland-Altman analyses showed increasing semi-automatic underestimation of intima measurements with increasing intimal extent. Comparing 3M to 12M progression between methods, mean intimal area showed minor underestimation (β-methodmean = - 1.03 mm2, p = 0.04). Lumen and media metrics showed excellent agreement between the manual and semi-automated method. Intima metrics and progressions from 3M to 12M were slightly underestimated by the semi-automated OCT software with unknown clinical relevance. The semi-automated software has the future potential to provide robust and time-saving evaluation of CAV progression.
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Affiliation(s)
- Niels Møller Jensen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, entrance F, Aarhus, Denmark.
- Iowa Institute for Biomedical Imaging, University of Iowa, L300 Pappajohn Biomedical Discovery Building (PBDB), 169 Newton Road, Iowa City, IA, 52242, USA.
| | - Zhi Chen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Tor Skibsted Clemmensen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, entrance F, Aarhus, Denmark
| | - Omeed Neghabat
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, entrance F, Aarhus, Denmark
- Iowa Institute for Biomedical Imaging, University of Iowa, L300 Pappajohn Biomedical Discovery Building (PBDB), 169 Newton Road, Iowa City, IA, 52242, USA
| | - Emil Nielsen Holck
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, entrance F, Aarhus, Denmark
- Iowa Institute for Biomedical Imaging, University of Iowa, L300 Pappajohn Biomedical Discovery Building (PBDB), 169 Newton Road, Iowa City, IA, 52242, USA
| | - Michal Pazdernik
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Lone Juul Hune Mogensen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, entrance F, Aarhus, Denmark
| | - Andreas Wahle
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Milan Sonka
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Hans Eiskjær
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, entrance F, Aarhus, Denmark
- Iowa Institute for Biomedical Imaging, University of Iowa, L300 Pappajohn Biomedical Discovery Building (PBDB), 169 Newton Road, Iowa City, IA, 52242, USA
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Velleca A, Shullo MA, Dhital K, Azeka E, Colvin M, DePasquale E, Farrero M, García-Guereta L, Jamero G, Khush K, Lavee J, Pouch S, Patel J, Michaud CJ, Shullo M, Schubert S, Angelini A, Carlos L, Mirabet S, Patel J, Pham M, Urschel S, Kim KH, Miyamoto S, Chih S, Daly K, Grossi P, Jennings D, Kim IC, Lim HS, Miller T, Potena L, Velleca A, Eisen H, Bellumkonda L, Danziger-Isakov L, Dobbels F, Harkess M, Kim D, Lyster H, Peled Y, Reinhardt Z. The International Society for Heart and Lung Transplantation (ISHLT) Guidelines for the Care of Heart Transplant Recipients. J Heart Lung Transplant 2022; 42:e1-e141. [PMID: 37080658 DOI: 10.1016/j.healun.2022.10.015] [Citation(s) in RCA: 64] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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5
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Velleca A, Shullo MA, Dhital K, Azeka E, Colvin M, DePasquale E, Farrero M, García-Guereta L, Jamero G, Khush K, Lavee J, Pouch S, Patel J, Michaud CJ, Shullo M, Schubert S, Angelini A, Carlos L, Mirabet S, Patel J, Pham M, Urschel S, Kim KH, Miyamoto S, Chih S, Daly K, Grossi P, Jennings D, Kim IC, Lim HS, Miller T, Potena L, Velleca A, Eisen H, Bellumkonda L, Danziger-Isakov L, Dobbels F, Harkess M, Kim D, Lyster H, Peled Y, Reinhardt Z. The International Society for Heart and Lung Transplantation (ISHLT) Guidelines for the Care of Heart Transplant Recipients. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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6
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Orban M, Dietl M, Dischl D, von Samson-Himmelstjerna P, Neubarth-Mayer J, Strüven A, Tengler A, Jakob A, Fischer M, Rizas K, Petzold T, Orban M, Braun D, Hausleiter J, Hagl C, Haas NA, Mehilli J, Pozza RD, Massberg S, Ulrich S. Assessment of sex- and age-dependency of risk factors for intimal hyperplasia in heart transplant patients using the high resolution of optical coherence tomography. Int J Cardiol 2022; 358:17-24. [DOI: 10.1016/j.ijcard.2022.04.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 02/26/2022] [Accepted: 04/12/2022] [Indexed: 11/30/2022]
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7
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Aleksova N, Chih S. Donor transmitted and de novo coronary plaque through the OCT magnifying lens. J Heart Lung Transplant 2022; 41:886-888. [DOI: 10.1016/j.healun.2022.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 03/29/2022] [Indexed: 10/18/2022] Open
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Laguë SL, Bone JN, Samuel R, Voss C, Balbacid E, Hosking MCK, Schubert S, Harris KC. Patterns of Early Coronary Artery Changes in Pediatric Heart Transplant Recipients Detected Using Optical Coherence Tomography. Circ Cardiovasc Imaging 2022; 15:e012486. [PMID: 35041446 DOI: 10.1161/circimaging.121.012486] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cardiac allograft vasculopathy, the leading cause of graft failure in pediatric heart transplant recipients, is characterized by diffuse and concentric coronary intimal thickening. Early treatment yields better outcomes. While coronary angiography is the standard for cardiac allograft vasculopathy screening and diagnosis, it only identifies luminal narrowing, which occurs in more severe disease. Coronary optical coherence tomography (OCT) is a high-definition intravascular imaging modality that may offer earlier diagnosis. We used OCT to investigate coronary intimal thickening in pediatric transplant recipients and examined its (1) location (ie, vessel type and location) and (2) nature (ie, characteristics of cross-sectional and longitudinal thickening). METHODS Sites collected coronary angiography and OCT data from participants (N=258 vessel segments from 73 individuals; median age: 11.5 years [8.4-15.3]; 55% male). Images were collected from the left anterior descending, left circumflex, and right coronary arteries, and location (ie, proximal, middle, and distal) were classified using coronary angiography. RESULTS OCT identified 32 vessel segments meeting criteria for significant thickening, 88% of which were angiographically silent. Longitudinal thickening was segmental rather than global in 88%, and cross-sectional thickening was 48% eccentric and 52% concentric. Intimal thickening prevalence and severity measures did not consistently differ between coronary artery type (P=1.000) or location (P=0.248) but increased with time since transplant and age at transplant and OCT procedure. CONCLUSIONS In pediatric transplant recipients, we observed a surprisingly high prevalence of segmental and eccentric intimal thickening. Insights from intravascular imaging suggest these patterns of coronary vascular changes may precede overt cardiac allograft vasculopathy. Identifying early changes may offer opportunity for enhanced surveillance and earlier intervention.
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Affiliation(s)
- Sabine L Laguë
- Department of Pediatrics, University of British Columbia, Vancouver, Canada (S.L.L.).,Division of Cardiology, Department of Pediatrics, British Columbia Children's Hospital, Vancouver, Canada (S.L.L., R.S., C.V., M.C.K.H., K.C.H.)
| | - Jeffrey N Bone
- British Columbia Children's Hospital Research Institute, Vancouver, Canada (J.N.B., E.B.)
| | - Rosh Samuel
- Division of Cardiology, Department of Pediatrics, British Columbia Children's Hospital, Vancouver, Canada (S.L.L., R.S., C.V., M.C.K.H., K.C.H.)
| | - Christine Voss
- Division of Cardiology, Department of Pediatrics, British Columbia Children's Hospital, Vancouver, Canada (S.L.L., R.S., C.V., M.C.K.H., K.C.H.)
| | - Enrique Balbacid
- British Columbia Children's Hospital Research Institute, Vancouver, Canada (J.N.B., E.B.)
| | - Martin C K Hosking
- Division of Cardiology, Department of Pediatrics, British Columbia Children's Hospital, Vancouver, Canada (S.L.L., R.S., C.V., M.C.K.H., K.C.H.)
| | - Stephan Schubert
- Pediatric Cardiology Department, La Paz Children's University Hospital, Madrid, Spain (S.S.).,German Heart Center Berlin, Department of Congenital Heart Disease - Pediatric Cardiology, Berlin, Germany (S.S.).,Center for Congenital Heart Disease/Pediatric Cardiology, Heart, and Diabetes Center NRW, University Clinic of Ruhr-University Bochum, Germany (S.S.).,Department of Pediatric Cardiology and Congenital Heart Disease, Deutsches Herzzentrum Berlin, Berlin, Germany (S.S.)
| | - Kevin C Harris
- Division of Cardiology, Department of Pediatrics, British Columbia Children's Hospital, Vancouver, Canada (S.L.L., R.S., C.V., M.C.K.H., K.C.H.)
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9
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Analysis of Fibrotic Plaques in Angiographic Manifest Cardiac Allograft Vasculopathy in Long-term Heart Transplanted Patients Using Optical Coherence Tomography. Transplant Direct 2021; 8:e1266. [PMID: 34966839 PMCID: PMC8710340 DOI: 10.1097/txd.0000000000001266] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 10/24/2021] [Accepted: 10/26/2021] [Indexed: 12/02/2022] Open
Abstract
Supplemental Digital Content is available in the text. 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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10
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Reddy SA, Khialani BV, Lambert B, Floré V, Brown AJ, Pettit SJ, West NE, Lewis C, Parameshwar J, Bhagra S, Kydd A, Hoole SP. Coronary imaging of cardiac allograft vasculopathy predicts current and future deterioration of left ventricular function in patients with orthotopic heart transplantation. Clin Transplant 2021; 36:e14523. [PMID: 34724254 DOI: 10.1111/ctr.14523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 09/19/2021] [Accepted: 10/18/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Intravascular ultrasound (IVUS) and optical coherence tomography (OCT) improve sensitivity of cardiac allograft vasculopathy (CAV) detection compared to invasive coronary angiography (ICA), but their ability to predict clinical events is unknown. We determined whether severe CAV detected with ICA, IVUS, or OCT correlates with graft function. METHODS Comparison of specific vessel parameters between IVUS and OCT on 20 patients attending for angiography 12-24 months post-orthotopic heart transplant. Serial left ventricular ejection fraction (EF) was recorded prospectively. RESULTS Analyzing 55 coronary arteries, OCT and IVUS correlated well for vessel CAV characteristics. A mean intimal thickness (MIT)OCT > .25 mm had a sensitivity of 86.7% and specificity of 74.3% at detecting Stanford grade 4 CAV. Those with angiographically evident CAV had significant reduction in graft EF over 7.3 years follow-up (median ΔEF -2% vs +1.5%, P = .03). Patients with MITOCT > .25 mm in at least one vessel had a lower median EF at time of surveillance (57% vs 62%, P = .014). Two MACEs were noted. CONCLUSION Imaging with OCT correlates well with IVUS for CAV detection. Combined angiography and OCT to screen for CAV within 12-24 months of transplant predicts concurrent and future deterioration in graft function.
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Affiliation(s)
- S Ashwin Reddy
- Department of Interventional Cardiology, Cambridge Biomedical Campus, Royal Papworth Hospital, Cambridge, UK
| | - Bharat V Khialani
- Department of Interventional Cardiology, Cambridge Biomedical Campus, Royal Papworth Hospital, Cambridge, UK
| | - Ben Lambert
- Department of Interventional Cardiology, Cambridge Biomedical Campus, Royal Papworth Hospital, Cambridge, UK
| | - Vintcent Floré
- Department of Interventional Cardiology, Cambridge Biomedical Campus, Royal Papworth Hospital, Cambridge, UK
| | - Adam J Brown
- Department of Interventional Cardiology, Cambridge Biomedical Campus, Royal Papworth Hospital, Cambridge, UK
| | - Steve J Pettit
- Transplant Unit, Cambridge Biomedical Campus, Royal Papworth Hospital, Cambridge, UK
| | - Nick Ej West
- Department of Interventional Cardiology, Cambridge Biomedical Campus, Royal Papworth Hospital, Cambridge, UK
| | - Clive Lewis
- Transplant Unit, Cambridge Biomedical Campus, Royal Papworth Hospital, Cambridge, UK
| | - Jayan Parameshwar
- Transplant Unit, Cambridge Biomedical Campus, Royal Papworth Hospital, Cambridge, UK
| | - Sai Bhagra
- Transplant Unit, Cambridge Biomedical Campus, Royal Papworth Hospital, Cambridge, UK
| | - Anna Kydd
- Transplant Unit, Cambridge Biomedical Campus, Royal Papworth Hospital, Cambridge, UK
| | - Stephen P Hoole
- Department of Interventional Cardiology, Cambridge Biomedical Campus, Royal Papworth Hospital, Cambridge, UK
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11
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Acharya D, Loyaga-Rendon RY, Chatterjee A, Rajapreyar I, Lee K. Optical Coherence Tomography in Cardiac Allograft Vasculopathy: State-of-the-Art Review. Circ Heart Fail 2021; 14:e008416. [PMID: 34414769 DOI: 10.1161/circheartfailure.121.008416] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cardiac allograft vasculopathy (CAV) is a challenging complication of heart transplantation. CAV pathophysiology is incompletely understood, standard screening modalities such as angiography have significant limitations, and currently available therapies have only modest efficacy in preventing progression. Optical coherence tomography is a light-based technique that provides microscopic level catheter-based intravascular imaging and has dramatically expanded our understanding of CAV, demonstrating it to be a complex, heterogeneous, and dynamic process. This review covers characteristics and uses of optical coherence tomography, including vessel characterization, serial use to assess progression of disease, guiding percutaneous intervention, and monitoring response to CAV therapies. We also discuss the potential of optical coherence tomography in providing individualized assessment and enable customized CAV therapies, which may lead to improvements in long-term transplant outcomes.
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Affiliation(s)
- Deepak Acharya
- University of Arizona Sarver Heart Center/Banner University Medical Center, Tucson (D.A., A.C., K.L.)
| | | | - Arka Chatterjee
- University of Arizona Sarver Heart Center/Banner University Medical Center, Tucson (D.A., A.C., K.L.)
| | | | - Kwan Lee
- University of Arizona Sarver Heart Center/Banner University Medical Center, Tucson (D.A., A.C., K.L.)
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12
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Abstract
Heart transplantation (HTx) remains the optimal treatment for selected patients with end-stage advanced heart failure. However, survival is limited early by acute rejection and long term by cardiac allograft vasculopathy (CAV). Even though the diagnosis of rejection is based on histology, cardiac imaging provides a pivotal role for early detection and severity assessment of these hazards. The present review focuses on the use and reliability of different invasive and non-invasive imaging modalities to detect and monitor CAV and rejection after HTx. Coronary angiography remains the corner stone in routine CAV surveillance. However, angiograms are invasive and underestimates the CAV severity especially in the early phase. Intravascular ultrasound and optical coherence tomography are invasive methods for intracoronary imaging that detects early CAV lesions not evident by angiograms. Non-invasive imaging can be divided into myocardial perfusion imaging, anatomical/structural imaging and myocardial functional imaging. The different non-invasive imaging modalities all provide clinical and prognostic information and may have a gatekeeper role for invasive monitoring. Acute rejection and CAV are still significant clinical problems after HTx. No imaging modality provides complete information on graft function, coronary anatomy and myocardial perfusion. However, a combination of invasive and non-invasive modalities at different stages following HTx should be considered for optimal personalized surveillance and risk stratification.
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Affiliation(s)
| | | | - Hans Eiskjær
- Department of Cardiology, Aarhus University Hospital, Denmark
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13
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Fine NM, Greenway SC, Mulvagh SL, Huang R, Maxon SA, Hepinstall MJ, Anderson JH, Johnson JN. Feasibility of Real-Time Myocardial Contrast Echocardiography to Detect Cardiac Allograft Vasculopathy in Pediatric Heart Transplant Recipients. J Am Soc Echocardiogr 2020; 34:503-510. [PMID: 33359634 DOI: 10.1016/j.echo.2020.12.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 12/15/2020] [Accepted: 12/15/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Cardiac allograft vasculopathy (CAV) is an important adverse prognostic factor for pediatric heart transplant (HT) recipients. Invasive coronary angiography (ICA) is the gold standard for CAV detection but lacks sensitivity for early microvascular changes and cumulative radiation exposure is of concern. Real-time myocardial contrast echocardiography (RTMCE) using ultrasound enhancing (contrast) agents performed during dobutamine stress echocardiography (DSE) can assess myocardial function, perfusion, and microvascular integrity. The objective of this study was to determine the safety and feasibility of RTMCE during DSE to detect CAV in a pediatric HT population. METHODS HT patients 10-21 years of age were recruited to undergo DSE with RTMCE to determine technical feasibility, test tolerability and adverse event rate, and detection of perfusion defects compared with ICA-detected CAV. Thirty-six patients from two centers were enrolled, with a mean age 13.5 ± 4.3 years; 21 (58%) were male. Wall motion and myocardial perfusion were qualitatively assessed and compared with ICA findings of CAV. Myocardial blood flow (MBF) at rest and peak stress was quantified, and myocardial blood flow reserve (MBFR) was defined as the ratio of peak to rest MBF. RESULTS Five (14%) patients had CAV by ICA, two with obstructive disease and three with mild CAV. Real-time myocardial contrast echocardiography was feasible in 32 (89%) patients. Three patients had wall motion defects, including one with a mixed defect and two with fixed defects. A perfusion abnormality was present in five patients, two of whom had obstructive CAV and one with mild CAV. Sensitivity and specificity of RTMCE for CAV detection were 60% and 94%, respectively, and diagnostic accuracy was 89%. MBFR assessment was feasible in 20 (63%) patients. The mean MBFR was 3.4 ± 0.7. Patients with CAV had lower MBFR than those without (2.0 ± 0.2 vs 3.7 ± 0.8; P < .01). There were no serious adverse events related to RTMCE. CONCLUSIONS Dobutamine stress RTMCE appears to be safe and feasible for the assessment of CAV in pediatric HT recipients. Further assessment is warranted to determine whether this noninvasive technique could provide a reliable alternative to ICA.
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Affiliation(s)
- Nowell M Fine
- Division of Cardiology, Departments of Cardiac Sciences and Community Health Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta.
| | - Steven C Greenway
- Section of Cardiology, Departments of Pediatrics, Cardiac Sciences, and Biochemistry and Molecular Biology, Libin Cardiovascular Institute, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Sharon L Mulvagh
- Division of Cardiology, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; Department of Cardiovascular Medicine, Mayo Clinic Children's Center, Mayo Clinic, Rochester, Minnesota
| | - Runqing Huang
- Department of Cardiovascular Medicine, Mayo Clinic Children's Center, Mayo Clinic, Rochester, Minnesota
| | - Shalon A Maxon
- Department of Cardiovascular Medicine, Mayo Clinic Children's Center, Mayo Clinic, Rochester, Minnesota
| | - Mary J Hepinstall
- Department of Cardiovascular Medicine, Mayo Clinic Children's Center, Mayo Clinic, Rochester, Minnesota
| | - Jason H Anderson
- Department of Cardiovascular Medicine, Mayo Clinic Children's Center, Mayo Clinic, Rochester, Minnesota; Division of Pediatric Cardiology, Mayo Clinic Children's Center, Mayo Clinic, Rochester, Minnesota
| | - Jonathan N Johnson
- Department of Cardiovascular Medicine, Mayo Clinic Children's Center, Mayo Clinic, Rochester, Minnesota; Division of Pediatric Cardiology, Mayo Clinic Children's Center, Mayo Clinic, Rochester, Minnesota
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Orban M, Ulrich S, Dischl D, von Samson-Himmelstjerna P, Schramm R, Tippmann K, Hein-Rothweiler R, Strüven A, Lehner A, Braun D, Hausleiter J, Jakob A, Fischer M, Hagl C, Haas N, Massberg S, Mehilli J, Robert DP. Cardiac allograft vasculopathy: Differences of absolute and relative intimal hyperplasia in children versus adults in optical coherence tomography. Int J Cardiol 2020; 328:227-234. [PMID: 33316256 DOI: 10.1016/j.ijcard.2020.12.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 12/01/2020] [Accepted: 12/04/2020] [Indexed: 01/06/2023]
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.
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Affiliation(s)
- Madeleine Orban
- Department of Cardiology, Ludwig-Maximilians-University, Klinikum Großhadern, Munich, Germany; Partner Site Munich Heart Alliance, German Centre for Cardiovascular Research (DZHK), Germany.
| | - Sarah Ulrich
- Department of Pediatric Cardiology and Intensive Care Medicine, Ludwig-Maximilians-University, Klinikum Großhadern, Munich, Germany
| | - Dominic Dischl
- Department of Cardiology, Ludwig-Maximilians-University, Klinikum Großhadern, Munich, Germany
| | | | - René Schramm
- Department of Heart Surgery, Ludwig-Maximilians-University, Klinikum Großhadern, Munich, Germany
| | - Katharina Tippmann
- Department of Cardiology, Ludwig-Maximilians-University, Klinikum Großhadern, Munich, Germany
| | - Ralph Hein-Rothweiler
- Department of Cardiology, Ludwig-Maximilians-University, Klinikum Großhadern, Munich, Germany
| | - Anna Strüven
- Department of Cardiology, Ludwig-Maximilians-University, Klinikum Großhadern, Munich, Germany
| | - Anja Lehner
- Department of Pediatric Cardiology and Intensive Care Medicine, Ludwig-Maximilians-University, Klinikum Großhadern, Munich, Germany
| | - Daniel Braun
- Department of Cardiology, Ludwig-Maximilians-University, Klinikum Großhadern, Munich, Germany
| | - Jörg Hausleiter
- Department of Cardiology, Ludwig-Maximilians-University, Klinikum Großhadern, Munich, Germany; Partner Site Munich Heart Alliance, German Centre for Cardiovascular Research (DZHK), Germany
| | - Andre Jakob
- Department of Pediatric Cardiology and Intensive Care Medicine, Ludwig-Maximilians-University, Klinikum Großhadern, Munich, Germany
| | - Marcus Fischer
- Department of Pediatric Cardiology and Intensive Care Medicine, Ludwig-Maximilians-University, Klinikum Großhadern, Munich, Germany
| | - Christian Hagl
- Department of Heart Surgery, Ludwig-Maximilians-University, Klinikum Großhadern, Munich, Germany; Partner Site Munich Heart Alliance, German Centre for Cardiovascular Research (DZHK), Germany
| | - Nikolaus Haas
- Department of Pediatric Cardiology and Intensive Care Medicine, Ludwig-Maximilians-University, Klinikum Großhadern, Munich, Germany
| | - Steffen Massberg
- Department of Cardiology, Ludwig-Maximilians-University, Klinikum Großhadern, Munich, Germany; Partner Site Munich Heart Alliance, German Centre for Cardiovascular Research (DZHK), Germany
| | - Julinda Mehilli
- Department of Cardiology, Ludwig-Maximilians-University, Klinikum Großhadern, Munich, Germany; Partner Site Munich Heart Alliance, German Centre for Cardiovascular Research (DZHK), Germany
| | - Dalla Pozza Robert
- Department of Pediatric Cardiology and Intensive Care Medicine, Ludwig-Maximilians-University, Klinikum Großhadern, Munich, Germany
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15
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Doumouras BS, Somerset E, Ross HJ. Letter by Doumouras et al Regarding Article, "Identification and Characterization of Trajectories of Cardiac Allograft Vasculopathy After Heart Transplantation: A Population-Based Study". Circulation 2020; 142:e407-e408. [PMID: 33284654 DOI: 10.1161/circulationaha.120.049661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Barbara S Doumouras
- Ted Rogers and Family Centre of Excellence in Heart Function (B.S.D., H.J.R.), Peter Munk Cardiac Centre, University Health Network, University of Toronto, Canada
| | - Emily Somerset
- Rogers Computational Program, Ted Rogers Centre for Heart Research (E.S.), Peter Munk Cardiac Centre, University Health Network, University of Toronto, Canada
| | - Heather J Ross
- Ted Rogers and Family Centre of Excellence in Heart Function (B.S.D., H.J.R.), Peter Munk Cardiac Centre, University Health Network, University of Toronto, Canada
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16
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Bjerre KP, Clemmensen TS, Poulsen SH, Hvas AM, Holm NR, Grove EL, Bouchelouche K, Kristensen SD, Eiskjaer H. Micro- and macrovascular cardiac allograft vasculopathy in relation to 91 cardiovascular biomarkers in heart transplant recipients-An exploratory study. Clin Transplant 2020; 35:e14133. [PMID: 33128247 DOI: 10.1111/ctr.14133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 10/20/2020] [Accepted: 10/21/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Cardiac allograft vasculopathy (CAV) limits survival after heart transplantation (HTx), and the pathogenesis is not fully clarified. We aimed to investigate a wide range of biomarkers and their correlation with micro- and macrovascular CAV and major adverse cardiac events in HTx patients. METHODS We evaluated 91 cardiovascular disease-related proteins in 48 HTx patients using a novel proteomic panel. Patients were dichotomized according to micro- and macrovascular CAV burden determined by coronary angiography, optical coherence tomography, and 15 O-H2 O positron emission tomography imaging. Major adverse cardiac events included significant CAV progression, heart failure, treated rejection, and cardiovascular death. RESULTS We found consistent differences in two proteins involved in cholesterol homeostasis: significantly increased proprotein convertase subtilisin/kexin type 9 (PCSK9) (p < .05) and significantly decreased paraoxonase 3 (PON3) (p < .05). N-terminal pro-brain natriuretic peptide (NT-proBNP) was significantly increased in patients with microvascular CAV (p < .05) and borderline significantly increased in patients experiencing major adverse cardiac events (p = .10) and patients with macrovascular CAV (p = .05). CONCLUSIONS We identified consistent changes in two proteins involved in cholesterol homeostasis which may be important players in the pathogenesis of CAV: PON3 and PCSK9. NT-proBNP also showed consistent changes across all groups but only reached statistical significance in patients with microvascular CAV. Our results warrant further validation in future studies.
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Affiliation(s)
| | | | - Steen Hvitfeldt Poulsen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Anne-Mette Hvas
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark.,Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
| | | | - Erik Lerkevang Grove
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Kirsten Bouchelouche
- Department of Nuclear Medicine & PET Center, Aarhus University Hospital, Aarhus, Denmark
| | - Steen Dalby Kristensen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Hans Eiskjaer
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
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17
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The role of optical coherence tomography and other intravascular imaging modalities in cardiac allograft vasculopathy. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2020; 16:19-29. [PMID: 32368233 PMCID: PMC7189132 DOI: 10.5114/aic.2020.93909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 02/13/2020] [Indexed: 11/17/2022] Open
Abstract
Orthotopic heart transplantation (OHT) is the standard-of-care for end-stage heart disease. Although a significant improvement in the prognosis of patients after OHT has been observed in recent years, their overall mortality remains relatively high, with a median survival of approximately 10 years after transplantation. One of the primary causes of death in patients after OHT is cardiac allograft vasculopathy (CAV), the condition developing specifically in the coronary vasculature after OHT, the pathophysiology of which is still inadequately known. It is estimated that CAV development and progression is responsible for approximately 30% of deaths within five years post-OHT. According to the International Society for Heart and Lung Transplantation (ISHLT) Nomenclature for CAV, its presence should be assessed primarily by the coronary angiography performed routinely after OHT, mostly due to its wide availability, reproducibility, and low complication rate. However, the analysis of CAV in coronary angiography has limitations, mostly concerning its - sometimes inadequate - sensitivity and specificity. Hence, there is a growing need for the introduction of more accurate methods of CAV assessment, such as intravascular imaging, which through a thorough evaluation of the arterial wall structure and thickness allows the drawbacks of routine angiography to be minimised. The aim of the article was to critically summarise the current findings derived from the analysis of CAV by optical coherence tomography, the other intravascular imaging modalities, such as intravascular ultrasound (IVUS) and IVUS-derived virtual histology, along with physiological assessment with the use of the fractional flow reserve.
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18
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Intravascular Imaging for Assessment of Cardiac Allograft Vasculopathy Following Heart Transplantation. CURRENT CARDIOVASCULAR IMAGING REPORTS 2020. [DOI: 10.1007/s12410-020-9525-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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19
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Pazdernik M, Wichterle D, Chen Z, Bedanova H, Kautzner J, Melenovsky V, Karmazin V, Malek I, Stiavnicky P, Tomasek A, Ozabalova E, Krejci J, Wahle A, Zhang H, Kovarnik T, Sonka M. Heart rate and early progression of cardiac allograft vasculopathy: A prospective study using highly automated 3-D optical coherence tomography analysis. Clin Transplant 2019; 34:e13773. [PMID: 31859379 DOI: 10.1111/ctr.13773] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 12/11/2019] [Accepted: 12/16/2019] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Heart rate slowing agents are frequently prescribed to manage heart transplant (HTx) patients with the assumption that higher heart rate is a risk factor in cardiovascular disease. PATIENTS AND METHODS This prospective two-center study investigated early progression of cardiac allograft vasculopathy (CAV) in 116 HTx patients. Examinations by coronary optical coherence tomography and 24-hour ambulatory ECG monitoring were performed both at baseline (1 month after HTx) and during follow-up (12 months after HTx). RESULTS During the first post-HTx year, we observed a significant reduction in the mean coronary luminal area from 9.0 ± 2.5 to 8.0 ± 2.4 mm2 (P < .001), and progression in mean intimal thickness (IT) from 106.5 ± 40.4 to 130.1 ± 53.0 µm (P < .001). No significant relationship was observed between baseline and follow-up mean heart rates and IT progression (R = .02, P = .83; R = -.13, P = .18). We found a mild inverse association between beta-blocker dosage at 12 months and IT progression (R = -.20, P = .035). CONCLUSION Our study did not confirm a direct association between mean heart rate and progression of CAV. The role of beta blockers warrants further investigation, with our results indicating that they may play a protective role in early CAV development.
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Affiliation(s)
- Michal Pazdernik
- Department of Cardiology, IKEM, Prague, Czech Republic.,Department of Cardiology, 2nd Medical School, Charles University, University Hospital Motol, Prague, Czech Republic
| | - Dan Wichterle
- Department of Cardiology, IKEM, Prague, Czech Republic.,2nd Department of Internal Medicine, Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
| | - Zhi Chen
- Iowa Institute for Biomedical Imaging, The University of Iowa, Iowa City, IA, USA
| | - Helena Bedanova
- Cardiovascular and Transplantation Surgery, Brno, Czech Republic
| | | | | | | | - Ivan Malek
- Department of Cardiology, IKEM, Prague, Czech Republic
| | | | - Ales Tomasek
- Cardiovascular and Transplantation Surgery, Brno, Czech Republic
| | - Eva Ozabalova
- Department of Cardiovascular Diseases, St. Anne's University Hospital and Masaryk University Brno, Brno, Czech Republic
| | - Jan Krejci
- Department of Cardiovascular Diseases, St. Anne's University Hospital and Masaryk University Brno, Brno, Czech Republic
| | - Andreas Wahle
- Iowa Institute for Biomedical Imaging, The University of Iowa, Iowa City, IA, USA
| | - Honghai Zhang
- Iowa Institute for Biomedical Imaging, The University of Iowa, Iowa City, IA, USA
| | - Tomas Kovarnik
- Department of Cardiology, IKEM, Prague, Czech Republic.,2nd Department of Internal Medicine, Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
| | - Milan Sonka
- Iowa Institute for Biomedical Imaging, The University of Iowa, Iowa City, IA, USA
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20
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McGovern E, Hosking MC, Balbacid E, Voss C, Berger F, Schubert S, Harris KC. Optical Coherence Tomography for the Early Detection of Coronary Vascular Changes in Children and Adolescents After Cardiac Transplantation. JACC Cardiovasc Imaging 2019; 12:2492-2501. [DOI: 10.1016/j.jcmg.2018.04.025] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 04/22/2018] [Accepted: 04/26/2018] [Indexed: 11/28/2022]
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21
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van Heeswijk RB, Bastiaansen JAM, Iglesias JF, Degrauwe S, Rotman S, Barras JL, Regamey J, Lauriers N, Tozzi P, Yerly J, Ginami G, Stuber M, Hullin R. Quantification of myocardial interstitial fibrosis and extracellular volume for the detection of cardiac allograft vasculopathy. Int J Cardiovasc Imaging 2019; 36:533-542. [DOI: 10.1007/s10554-019-01733-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 11/09/2019] [Indexed: 01/06/2023]
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22
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Kollar B, Kamat P, Klein H, Waldner M, Schweizer R, Plock J. The Significance of Vascular Alterations in Acute and Chronic Rejection for Vascularized Composite Allotransplantation. J Vasc Res 2019; 56:163-180. [DOI: 10.1159/000500958] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 05/14/2019] [Indexed: 11/19/2022] Open
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23
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Olymbios M, Kwiecinski J, Berman DS, Kobashigawa JA. Imaging in Heart Transplant Patients. JACC Cardiovasc Imaging 2018; 11:1514-1530. [DOI: 10.1016/j.jcmg.2018.06.019] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 04/30/2018] [Accepted: 06/07/2018] [Indexed: 01/06/2023]
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24
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Cote AT, Hosking M, Voss C, Human DG, Sandor GGS, Harris KC. Coronary artery intimal thickening and ventricular dynamics in pediatric heart transplant recipients. CONGENIT HEART DIS 2018; 13:663-670. [DOI: 10.1111/chd.12629] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 05/18/2018] [Accepted: 05/21/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Anita T. Cote
- Department of Pediatrics; University of British Columbia & British Columbia Children’s Hospital Research Institute; Vancouver Canada
- School of Human Kinetics; Trinity Western University; Langley Canada
| | - Martin Hosking
- British Columbia Children’s Hospital, Children’s Heart Centre; Vancouver Canada
| | - Christine Voss
- Department of Pediatrics; University of British Columbia & British Columbia Children’s Hospital Research Institute; Vancouver Canada
- British Columbia Children’s Hospital, Children’s Heart Centre; Vancouver Canada
| | - Derek G Human
- British Columbia Children’s Hospital, Children’s Heart Centre; Vancouver Canada
| | - George G. S. Sandor
- Department of Pediatrics; University of British Columbia & British Columbia Children’s Hospital Research Institute; Vancouver Canada
- British Columbia Children’s Hospital, Children’s Heart Centre; Vancouver Canada
| | - Kevin C. Harris
- Department of Pediatrics; University of British Columbia & British Columbia Children’s Hospital Research Institute; Vancouver Canada
- British Columbia Children’s Hospital, Children’s Heart Centre; Vancouver Canada
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25
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Pazdernik M, Chen Z, Bedanova H, Kautzner J, Melenovsky V, Karmazin V, Malek I, Tomasek A, Ozabalova E, Krejci J, Franekova J, Wahle A, Zhang H, Kovarnik T, Sonka M. Early detection of cardiac allograft vasculopathy using highly automated 3-dimensional optical coherence tomography analysis. J Heart Lung Transplant 2018; 37:992-1000. [DOI: 10.1016/j.healun.2018.04.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 03/08/2018] [Accepted: 04/03/2018] [Indexed: 11/29/2022] Open
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26
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Lee FJ, Shiekh I, Nguyen T, Nguyen M. Bioresorbable Vascular Scaffold in the Midportion of the Left Anterior Descending Artery for Cardiac Allograft Vasculopathy in a Cardiac Transplant Patient. CARDIOVASCULAR INNOVATIONS AND APPLICATIONS 2018. [DOI: 10.15212/cvia.2017.0019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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27
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Clemmensen TS, Holm NR, Eiskjær H, Jakobsen L, Berg K, Neghabat O, Løgstrup BB, Christiansen EH, Dijkstra J, Terkelsen CJ, Maeng M, Poulsen SH. Detection of early changes in the coronary artery microstructure after heart transplantation: A prospective optical coherence tomography study. J Heart Lung Transplant 2018; 37:486-495. [DOI: 10.1016/j.healun.2017.10.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 10/02/2017] [Accepted: 10/18/2017] [Indexed: 11/25/2022] Open
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28
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Gates KV, Pereira NL, Griffiths LG. Cardiac Non-Human Leukocyte Antigen Identification: Techniques and Troubles. Front Immunol 2017; 8:1332. [PMID: 29093713 PMCID: PMC5651233 DOI: 10.3389/fimmu.2017.01332] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 10/02/2017] [Indexed: 12/20/2022] Open
Abstract
Historically efforts have focused on the human leukocyte antigen (HLA) as the major cause for acute and chronic rejection following cardiac transplantation. However, rising evidence indicates that non-HLA antibodies can be both primary initiators and modifiers of antibody-mediated rejection (AMR) and cardiac allograft vasculopathy (CAV). The purpose of this review is to assess currently available technologies for non-HLA identification and leveraging such responses toward antibody quantification. Several techniques have been used to identify antigenic determinants of recipient graft-specific non-HLA humoral immune responses, but each comes with its own set of benefits and caveats. Improving our ability to detect non-HLA humoral immune response will aid in our understanding of the underlying antigenic determinants of AMR and CAV, as well as improve patient outcomes.
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Affiliation(s)
- Katherine V Gates
- Department of Veterinary Medicine and Epidemiology, University of California, Davis, Davis, CA, United States.,Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, United States
| | - Naveen L Pereira
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, United States
| | - Leigh G Griffiths
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, United States
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Clemmensen TS, Holm NR, Eiskjær H, Løgstrup BB, Christiansen EH, Dijkstra J, Barkholt TØ, Terkelsen CJ, Maeng M, Poulsen SH. Layered Fibrotic Plaques Are the Predominant Component in Cardiac Allograft Vasculopathy. JACC Cardiovasc Imaging 2017; 10:773-784. [DOI: 10.1016/j.jcmg.2016.10.021] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 09/22/2016] [Accepted: 10/20/2016] [Indexed: 10/20/2022]
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30
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Baran DA. Shedding Light on Cardiac Allograft Vasculopathy. JACC Cardiovasc Imaging 2017; 10:785-786. [DOI: 10.1016/j.jcmg.2016.12.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 12/15/2016] [Indexed: 01/25/2023]
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Abstract
PURPOSE OF REVIEW Cardiac allograft vasculopathy (CAV) is a major limitation to long-term survival after heart transplantation. Innovative new techniques to diagnose CAV have been applied to detect disease. This review will examine the current diagnostic and treatment options available to clinicians for CAV. RECENT FINDINGS Diagnostic modalities addressing the pathophysiology underlying CAV (arterial wall thickening and decreased coronary blood flow) improve diagnostic sensitivity when compared to traditional (angiography and dobutamine stress echocardiography) techniques. SUMMARY Limited options are available to prevent and treat CAV; however, progress has been made in making an earlier and more accurate diagnosis. Future research is needed to identify the optimal time to modify immunosuppression and investigate novel treatments for CAV.
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32
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Relationship between markers of plaque vulnerability in optical coherence tomography and atherosclerotic progression in adult patients with heart transplantation. J Heart Lung Transplant 2017; 36:185-192. [DOI: 10.1016/j.healun.2016.06.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 05/05/2016] [Accepted: 06/01/2016] [Indexed: 02/03/2023] Open
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33
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McDiarmid AK, Plein S, Ross HJ. Emerging imaging techniques after cardiac transplantation. J Heart Lung Transplant 2016; 35:1399-1411. [PMID: 27523792 DOI: 10.1016/j.healun.2016.06.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 05/13/2016] [Accepted: 06/22/2016] [Indexed: 10/21/2022] Open
Abstract
Improvements in survival after cardiac transplantation have in part been driven by improved graft surveillance. Graft surveillance relies mainly on 3 techniques: coronary angiography, endomyocardial biopsy and echocardiography. Developments in invasive and non-invasive imaging technology have revolutionized assessment of the heart in both health and disease, offering new insights into tissue composition and myocardial metabolism. Herein we aim to review the strengths and weaknesses of these techniques, and summarize the evidence in the following 5 fields of cardiac imaging after transplantation: cardiovascular magnetic resonance; computed tomography; positron emission tomography; single-photon emission computed tomography; and optical coherence tomography and molecular imaging techniques.
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Affiliation(s)
- Adam K McDiarmid
- Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada; Multidisciplinary Cardiovascular Research Centre and Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
| | - Sven Plein
- Multidisciplinary Cardiovascular Research Centre and Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Heather J Ross
- Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
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34
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Payne GA, Hage FG, Acharya D. Transplant allograft vasculopathy: Role of multimodality imaging in surveillance and diagnosis. J Nucl Cardiol 2016; 23:713-27. [PMID: 26711101 DOI: 10.1007/s12350-015-0373-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 11/27/2015] [Indexed: 01/22/2023]
Abstract
Cardiac allograft vasculopathy (CAV) is a challenging long-term complication of cardiac transplantation and remains a leading long-term cause of graft failure, re-transplantation, and death. CAV is an inflammatory vasculopathy distinct from traditional atherosclerotic coronary artery disease. Historically, the surveillance and diagnosis of CAV has been dependent on serial invasive coronary angiography with intravascular imaging. Although commonly practiced, angiography is not without significant limitations. Technological advances have provided sophisticated imaging techniques for CAV assessment. It is now possible to assess the vascular lumen, vessel wall characteristics, absolute blood flow, perfusion reserve, myocardial contractile function, and myocardial metabolism and injury in a noninvasive, expeditious manner with little risk. The current article will review key imaging modalities for the surveillance, diagnosis, and prognosis of CAV and discuss coronary physiology of transplanted hearts with emphasis on the clinical implications for provocative and vasodilator stress testing.
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Affiliation(s)
- Gregory A Payne
- Division of Cardiovascular Disease, University of Alabama at Birmingham School of Medicine, Tinsley Harrison Tower, Room 321, Birmingham, AL, 35294-006, USA
| | - Fadi G Hage
- Division of Cardiovascular Disease, University of Alabama at Birmingham School of Medicine, Tinsley Harrison Tower, Room 321, Birmingham, AL, 35294-006, USA
- Section of Cardiology, Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA
| | - Deepak Acharya
- Division of Cardiovascular Disease, University of Alabama at Birmingham School of Medicine, Tinsley Harrison Tower, Room 321, Birmingham, AL, 35294-006, USA.
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Tomai F, De Luca L, Petrolini A, Di Vito L, Ghini AS, Corvo P, De Persio G, Parisi F, Pongiglione G, Giulia Gagliardi M, Prati F. Optical coherence tomography for characterization of cardiac allograft vasculopathy in late survivors of pediatric heart transplantation. J Heart Lung Transplant 2016; 35:74-79. [DOI: 10.1016/j.healun.2015.08.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Revised: 07/14/2015] [Accepted: 08/27/2015] [Indexed: 01/25/2023] Open
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The basics of intravascular optical coherence tomography. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2015; 11:74-83. [PMID: 26161097 PMCID: PMC4495121 DOI: 10.5114/pwki.2015.52278] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 01/12/2015] [Accepted: 05/09/2015] [Indexed: 12/23/2022] Open
Abstract
Optical coherence tomography (OCT) has opened new horizons for intravascular coronary imaging. It utilizes near-infrared light to provide a microscopic insight into the pathology of coronary arteries in vivo. Optical coherence tomography is also capable of identifying the chemical composition of atherosclerotic plaques and detecting traits of their vulnerability. At present it is the only tool to measure the thickness of the fibrous cap covering the lipid core of the atheroma, and thus it is an exceptional modality to detect plaques that are prone to rupture (thin fibrous cap atheromas). Moreover, it facilitates distinguishing between plaque rupture and plaque erosion as a cause of acute intracoronary thrombosis. Optical coherence tomography is applied to guide angioplasties of coronary lesions and to assess outcomes of percutaneous coronary interventions broadly. It identifies stent malapposition, dissections, and thrombosis with unprecedented precision. Furthermore, OCT helps to monitor vessel healing after stenting. It evaluates the coverage of stent struts by the neointima and detects in-stent neoatherosclerosis. With so much potential, new studies are warranted to determine OCT's clinical impact. The following review presents the technical background, basics of OCT image interpretation, and practical tips for adequate OCT imaging, and outlines its established and potential clinical application.
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Sinclair H, Bourantas C, Bagnall A, Mintz GS, Kunadian V. OCT for the Identification of Vulnerable Plaque in Acute Coronary Syndrome. JACC Cardiovasc Imaging 2015; 8:198-209. [DOI: 10.1016/j.jcmg.2014.12.005] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 12/04/2014] [Accepted: 12/09/2014] [Indexed: 12/22/2022]
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Guddeti RR, Matsuo Y, Matsuzawa Y, Aoki T, Lerman LO, Kushwaha SS, Lerman A. Clinical Implications of Intracoronary Imaging in Cardiac Allograft Vasculopathy. Circ Cardiovasc Imaging 2015; 8:CIRCIMAGING.114.002636. [DOI: 10.1161/circimaging.114.002636] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Raviteja R. Guddeti
- From the Division of Cardiovascular Diseases, Mayo College of Medicine, Rochester, MN (R.R.G., Y.M., Y.M., T.A., S.S.K., A.L.); and Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN (L.O.L.)
| | - Yoshiki Matsuo
- From the Division of Cardiovascular Diseases, Mayo College of Medicine, Rochester, MN (R.R.G., Y.M., Y.M., T.A., S.S.K., A.L.); and Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN (L.O.L.)
| | - Yasushi Matsuzawa
- From the Division of Cardiovascular Diseases, Mayo College of Medicine, Rochester, MN (R.R.G., Y.M., Y.M., T.A., S.S.K., A.L.); and Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN (L.O.L.)
| | - Tatsuo Aoki
- From the Division of Cardiovascular Diseases, Mayo College of Medicine, Rochester, MN (R.R.G., Y.M., Y.M., T.A., S.S.K., A.L.); and Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN (L.O.L.)
| | - Lilach O. Lerman
- From the Division of Cardiovascular Diseases, Mayo College of Medicine, Rochester, MN (R.R.G., Y.M., Y.M., T.A., S.S.K., A.L.); and Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN (L.O.L.)
| | - Sudhir S. Kushwaha
- From the Division of Cardiovascular Diseases, Mayo College of Medicine, Rochester, MN (R.R.G., Y.M., Y.M., T.A., S.S.K., A.L.); and Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN (L.O.L.)
| | - Amir Lerman
- From the Division of Cardiovascular Diseases, Mayo College of Medicine, Rochester, MN (R.R.G., Y.M., Y.M., T.A., S.S.K., A.L.); and Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN (L.O.L.)
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Dedieu N, Greil G, Wong J, Fenton M, Burch M, Hussain T. Diagnosis and management of coronary allograft vasculopathy in children and adolescents. World J Transplant 2014; 4:276-293. [PMID: 25540736 PMCID: PMC4274597 DOI: 10.5500/wjt.v4.i4.276] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Revised: 08/12/2014] [Accepted: 09/17/2014] [Indexed: 02/05/2023] Open
Abstract
Coronary allograft vasculopathy remains one of the leading causes of death beyond the first year post transplant. As a result of denervation following transplantation, patients lack ischaemic symptoms and presentation is often late when the graft is already compromised. Current diagnostic tools are rather invasive, or in case of angiography, significantly lack sensitivity. Therefore a non-invasive tool that could allow early diagnosis would be invaluable.This paper review the disease form its different diagnosis techniques,including new and less invasive diagnostic tools to its pharmacological management and possible treatments.
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Salvadori M, Bertoni E. What's new in clinical solid organ transplantation by 2013. World J Transplant 2014; 4:243-66. [PMID: 25540734 PMCID: PMC4274595 DOI: 10.5500/wjt.v4.i4.243] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 07/11/2014] [Accepted: 07/27/2014] [Indexed: 02/05/2023] Open
Abstract
Innovative and exciting advances in the clinical science in solid organ transplantation continuously realize as the results of studies, clinical trials, international conferences, consensus conferences, new technologies and discoveries. This review will address to the full spectrum of news in transplantation, that verified by 2013. The key areas covered are the transplantation activity, with particular regards to the donors, the news for solid organs such as kidney, pancreas, liver, heart and lung, the news in immunosuppressive therapies, the news in the field of tolerance and some of the main complications following transplantation as infections and cancers. The period of time covered by the study starts from the international meetings held in 2012, whose results were published in 2013, up to the 2013 meetings, conferences and consensus published in the first months of 2014. In particular for every organ, the trends in numbers and survival have been reviewed as well as the most relevant problems such as organ preservation, ischemia reperfusion injuries, and rejections with particular regards to the antibody mediated rejection that involves all solid organs. The new drugs and strategies applied in organ transplantation have been divided into new way of using old drugs or strategies and drugs new not yet on the market, but on phase Ito III of clinical studies and trials.
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Non-invasive screening for cardiac allograft vasculopathy: go small or go home? J Heart Lung Transplant 2014; 34:158-60. [PMID: 25511745 DOI: 10.1016/j.healun.2014.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 10/11/2014] [Accepted: 11/04/2014] [Indexed: 11/23/2022] Open
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Davis MK, Hunt SA. State of the art: Cardiac transplantation. Trends Cardiovasc Med 2014; 24:341-9. [DOI: 10.1016/j.tcm.2014.08.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 08/19/2014] [Accepted: 08/20/2014] [Indexed: 12/20/2022]
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Vignali L, Solinas E, Emanuele E. Research and clinical applications of optical coherence tomography in invasive cardiology: a review. Curr Cardiol Rev 2014; 10:369-76. [PMID: 24893934 PMCID: PMC4101202 DOI: 10.2174/1573403x10666140604120753] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 05/29/2014] [Accepted: 06/01/2014] [Indexed: 11/22/2022] Open
Abstract
In cardiology, optical coherence tomography (OCT) is an invasive imaging technique based on the principle of light coherence. This system was developed to obtain three-dimensional high resolution images to examine coronary artery normal and/or pathological structure. This technique replaces the ultrasound used by its main alternative procedure, intravascular ultrasound, by a near-infrared light source. Acute coronary syndromes due to atherosclerotic vascular disease are the leading cause of mortality in developed and developing countries. As a consequence, intravascular imaging systems became an important area of research and 1991 marks the first use of OCT in coronary artery observations. Since its first appearance in invasive cardiology, OCT maintains a strong presence in the research environments for the identification of vulnerable plaques, as it is able to overcome difficulties presented by other techniques such as virtual intravascular ultrasound, near-infrared spectroscopy, and histology. Moreover, OCT is increasingly being used in the clinical practice as a guide during coronary interventions and in the assessment of vascular response after coronary stent implantation. This review focuses on the relevance of OCT in research and clinical applications in the field of invasive cardiology and discusses the future directions of the field.
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Affiliation(s)
| | | | - Enzo Emanuele
- Living Research s.a.s., Via Monte Grappa, 13, I-27038, Robbio (PV), Italy.
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Greenway SC, Hosking M, Harris KC. Optical coherence tomography for the evaluation of asymmetric cardiac allograft vasculopathy in a child. Pediatr Transplant 2014; 18:E190-2. [PMID: 24953969 DOI: 10.1111/petr.12303] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/13/2014] [Indexed: 11/30/2022]
Abstract
We present an unusual case of CAV in a child with isolated disease in the LAD coronary artery. Initial progression of the disease appeared to have been halted by the use of sirolimus, but the assessment of disease in other vessels (particularly the RCA) was of particular importance in deciding whether or not to relist this patient for transplantation. Due to the known limitations of coronary angiography, we used OCT to assess for angiographically silent CAV. The normal intravascular appearance of the RCA by OCT was reassuring, and the child was not relisted for transplantation. OCT offers multiple advantages for the assessment of CAV in children.
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Affiliation(s)
- Steven C Greenway
- Section of Cardiology and Department of Pediatrics, Alberta Children's Hospital, Calgary, AB, Canada
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Clemmensen TS, Løgstrup BB, Eiskjær H, Poulsen SH. Evaluation of longitudinal myocardial deformation by 2-dimensional speckle-tracking echocardiography in heart transplant recipients: relation to coronary allograft vasculopathy. J Heart Lung Transplant 2014; 34:195-203. [PMID: 25108908 DOI: 10.1016/j.healun.2014.07.008] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 05/26/2014] [Accepted: 07/10/2014] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Coronary allograft vasculopathy (CAV) in heart transplant (HTx) recipients is characterized by diffuse affection of epicardial and intramyocardial coronary vessels. Despite significant CAV and anticipated affected myocardial function, left ventricular ejection fraction (LVEF) is often within the normal range, indicating the need of more sophisticated non-invasive methods to detect impaired myocardial function caused by CAV. Global longitudinal strain (GLS) represents a new echocardiographic measurement of systolic myocardial deformation. The aim of the study was to evaluate the relation between GLS measured by 2-dimensional speckle-tracking echocardiography and CAV in HTx patients. METHODS The study included 178 HTx patients and 20 healthy, age-matched individuals. All patients had an extensive echocardiographic evaluation and coronary angiography assessing CAV. CAV was classified according to International Society of Heart and Lung Transplantation classification (CAV0-3). RESULTS CAV was seen in 38.8% of patients. Compared with controls (-20.6% ± 1.4%), GLS was significantly reduced according to the degree of CAV (CAV0, -16.7% ± 2.4%; CAV1, -15.2% ± 2.9%; CAV2-3, -14.0% ± 3.8%; controls, -20.6% ±1.4%; pTREND < 0.0001). In addition, we found decreasing peak systolic mitral annular velocities (pTREND = 0.0040), tissue-tracking values (pTREND = 0.0002), and LVEF according to CAV class (CAV0, 65.3% ± 5.4%; CAV2-3, 56.9% ± 11.7%; pTREND < 0.0001). The HTx population showed significant restrictive physiology compared with the control population, but no significant correlation was seen between CAV class and traditional diastolic parameters such as E/A ratio (pTREND = 0.38) or E-deceleration time (pTREND = 0.14). CONCLUSIONS In contrast to LVEF and conventional pulsed mitral Doppler flow parameters used in the CAV classification, GLS relates to the presence and degree of CAV. The present results suggest GLS as a new method to be included in the monitoring of graft function in relation to CAV.
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Affiliation(s)
| | | | - Hans Eiskjær
- Department of Cardiology, Aarhus University Hospital, Skejby, Denmark
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Harris KC, Manouzi A, Fung AY, De Souza A, Bezerra HG, Potts JE, Hosking MC. Feasibility of Optical Coherence Tomography in Children With Kawasaki Disease and Pediatric Heart Transplant Recipients. Circ Cardiovasc Imaging 2014; 7:671-8. [DOI: 10.1161/circimaging.113.001764] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Optical coherence tomography (OCT) is a high-resolution intravascular imaging technique used in adults. We tested the hypothesis that OCT could identify coronary abnormalities not seen by angiography in children with a history of Kawasaki disease (KD) and pediatric heart transplant (TX) recipients.
Methods and Results—
Patients with KD and TX recipients were evaluated between December 2012 and October 2013 with angiography and OCT (Ilumien System, LightLabs, St Jude Medical, Westford, MA). Modifications were made to the adult OCT protocol to adapt this technique for children. Serial cross-sectional area measurements of the lumen, intima, and media were made. Entire imaging data were analyzed for the presence of qualitative changes. Seventeen children were evaluated (5 patients with KD; 12 TX recipients). In patients with KD, angiography was normal. However, OCT imaging revealed that significant vessel wall abnormalities were present in all children including intimal thickening (intima/lumen cross-sectional area ratio>0.4), loss of the normal layered structure of the vessel wall, white thrombus, calcification, and neovascularization. There was extensive destruction of the internal elastic lamina. In TX recipients, angiography was normal; however, intimal thickening (intima/media cross-sectional area ratio>1) was seen in 9 of 12 patients. The median intima/media cross-sectional area ratio was 1.18.
Conclusions—
In this initial experience with OCT in children, we have identified significant coronary abnormalities with OCT that are angiographically silent in children with a history of coronary aneurysms because of KD and in pediatric TX recipients.
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Affiliation(s)
- Kevin C. Harris
- From the Division of Pediatric Cardiology, Department of Pediatrics (K.C.H., A.M., A.D.S., J.E.P., M.C.K.H.) and Division of Cardiology, Department of Medicine (A.Y.F.), University of British Columbia, Vancouver, Canada; and Division of Cardiology, Department of Medicine, Case Western Reserve University, Cleveland, OH (H.G.B.)
| | - Anas Manouzi
- From the Division of Pediatric Cardiology, Department of Pediatrics (K.C.H., A.M., A.D.S., J.E.P., M.C.K.H.) and Division of Cardiology, Department of Medicine (A.Y.F.), University of British Columbia, Vancouver, Canada; and Division of Cardiology, Department of Medicine, Case Western Reserve University, Cleveland, OH (H.G.B.)
| | - Anthony Y. Fung
- From the Division of Pediatric Cardiology, Department of Pediatrics (K.C.H., A.M., A.D.S., J.E.P., M.C.K.H.) and Division of Cardiology, Department of Medicine (A.Y.F.), University of British Columbia, Vancouver, Canada; and Division of Cardiology, Department of Medicine, Case Western Reserve University, Cleveland, OH (H.G.B.)
| | - Astrid De Souza
- From the Division of Pediatric Cardiology, Department of Pediatrics (K.C.H., A.M., A.D.S., J.E.P., M.C.K.H.) and Division of Cardiology, Department of Medicine (A.Y.F.), University of British Columbia, Vancouver, Canada; and Division of Cardiology, Department of Medicine, Case Western Reserve University, Cleveland, OH (H.G.B.)
| | - Hiram G. Bezerra
- From the Division of Pediatric Cardiology, Department of Pediatrics (K.C.H., A.M., A.D.S., J.E.P., M.C.K.H.) and Division of Cardiology, Department of Medicine (A.Y.F.), University of British Columbia, Vancouver, Canada; and Division of Cardiology, Department of Medicine, Case Western Reserve University, Cleveland, OH (H.G.B.)
| | - James E. Potts
- From the Division of Pediatric Cardiology, Department of Pediatrics (K.C.H., A.M., A.D.S., J.E.P., M.C.K.H.) and Division of Cardiology, Department of Medicine (A.Y.F.), University of British Columbia, Vancouver, Canada; and Division of Cardiology, Department of Medicine, Case Western Reserve University, Cleveland, OH (H.G.B.)
| | - Martin C.K. Hosking
- From the Division of Pediatric Cardiology, Department of Pediatrics (K.C.H., A.M., A.D.S., J.E.P., M.C.K.H.) and Division of Cardiology, Department of Medicine (A.Y.F.), University of British Columbia, Vancouver, Canada; and Division of Cardiology, Department of Medicine, Case Western Reserve University, Cleveland, OH (H.G.B.)
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Dong L, Maehara A, Nazif TM, Pollack AT, Saito S, Rabbani LE, Apfelbaum MA, Dalton K, Moses JW, Jorde UP, Xu K, Mintz GS, Mancini DM, Weisz G. Optical coherence tomographic evaluation of transplant coronary artery vasculopathy with correlation to cellular rejection. Circ Cardiovasc Interv 2014; 7:199-206. [PMID: 24714488 DOI: 10.1161/circinterventions.113.000949] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cardiac allograft vasculopathy is an accelerated fibroproliferative process that affects the coronary arteries of transplanted hearts. Intracoronary imaging with optical coherence tomography enables detection of subangiographic cardiac allograft vasculopathy. METHODS AND RESULTS At the time of routine surveillance coronary angiography, 48 consecutive heart transplant recipients underwent optical coherence tomographic imaging of 1 coronary artery. Imaging findings were compared per rejection history that was graded according to the International Society of Heart and Lung Transplantation classification as none/mild (International Society of Heart and Lung Transplantation 0, 1A/1B, or 2) or high-grade rejection (≥3A). Compared with the none/mild rejection group (37 patients) using Mann-Whitney U test, patients in the high-grade rejection group (11 patients) had a thicker intima in all coronary segments (distal: 0.22 mm [0.09-0.41] versus 0.09 mm [0.06-0.17], P=0.02; middle: 0.35 mm [0.00-0.45] versus 0.14 mm [0.08-0.24], P=0.002; and proximal: 0.34 mm [0.21-0.44] versus 0.15 mm [0.11-0.21], P=0.005) and a higher prevalence of foamy macrophages (distal: 55% versus 9%, P=0.003; middle: 55% versus 22%, P=0.004; and proximal: 44% versus 13%, P=0.05) using χ(2) statistics. Side branches in the high-grade rejection group had smaller lumen diameters and a higher prevalence of intimal thickening (54% versus 36%; P=0.01). Intimal microvessels were also more prevalent in the high-grade rejection group versus the none/mild rejection group (46% versus 11%; P=0.02). CONCLUSIONS Coronary optical coherence tomographic evaluation revealed that patients with a history of high-grade cellular rejection, compared with those with none/mild rejection, had more coronary artery intimal thickening with macrophage infiltration, involving all coronary segments and side branches. CLINICAL TRIAL REGISTRATION URL http://www.clinicaltrials.gov. Unique identifier: NCT01403142.
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Affiliation(s)
- Liang Dong
- From the NewYork Presbyterian Hospital, Columbia University Medical Center, New York, NY (L.D., A.M., T.M.N., A.T.P., S.S., L.E.R., M.A.A., K.D., J.W.M., U.P.J., D.M.M., G.W.); the Cardiovascular Research Foundation, New York, NY (L.D., A.M., S.S., J.W.M., K.X., G.S.M., G.W.); The Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang, China (L.D.); and Shaare Zedek Medical Center, Jerusalem, Israel (G.W.)
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Imamura T, Kinugawa K, Murasawa T, Kagami Y, Endo M, Muraoka H, Fujino T, Inaba T, Maki H, Hatano M, Kinoshita O, Nawata K, Kyo S, Komuro I, Ono M. Cardiac allograft vasculopathy can be distinguished from donor-transmitted coronary atherosclerosis by optical coherence tomography imaging in a heart transplantation recipient: double layered intimal thickness. Int Heart J 2014; 55:178-80. [PMID: 24632967 DOI: 10.1536/ihj.13-279] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Although survival after heart transplantation (HTx) has improved in recent years, cardiac allograft vasculopathy (CAV) is still the leading cause of remote morbidity and mortality in HTx recipients, partly because of difficulty with its diagnosis. In general, routine surveillance for CAV is advocated with coronary angiography accompanied by intravascular ultrasound (IVUS) if necessary. However, these modalities have limitations with respect to low spatial resolution, and sufficient qualitative/quantitative assessment of coronary intima has not been accomplished. Recently, optical coherence tomography (OCT) has emerged as a novel intracoronary imaging technique using an optical analogue of ultrasound with a spatial resolution of 10-20 µm, which is 10 times greater than IVUS. We here experienced a 49-year-old male who received a HTx 3 years ago, and OCT was executed during low molecular weight dextran injection. OCT demonstrated distinct double intimal layers probably consisting of a donor-transmitted atherosclerotic layer and an inner intimal proliferation due to CAV, which was indistinguishable by IVUS and virtual histological analyses. We believe that OCT imaging is not only a new loadstar during treatment of CAV but also a new generation modality for screening for early CAV in HTx recipients.
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Affiliation(s)
- Teruhiko Imamura
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo
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