Document Detail


Coronary atherosclerosis with vulnerable plaque and complicated lesions in transplant recipients: new insight into cardiac allograft vasculopathy by optical coherence tomography.
MedLine Citation:
PMID:  23801824     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
AIMS: Cardiac allograft vasculopathy (CAV) is a major limitation to long-term survival following cardiac transplantation. Conventional imaging modalities such as angiography and intravascular ultrasound fail to characterize CAV plaque morphology. Our aim was to characterize CAV in vivo using the high spatial resolution of intracoronary optical coherence tomography (OCT).
METHODS AND RESULTS: We prospectively enrolled 53 cardiac transplant patients to undergo OCT of the left anterior descending coronary artery (LAD) in addition to annual CAV screening by coronary angiography and intravascular ultrasound (IVUS). The proximal 30 mm of the LAD was divided into three segments of 10 mm each (n = 156). Segments with CAV plaque on IVUS were analysed by OCT for specific CAV morphological characteristics within the framework of three groups according to follow-up time after heart transplantation: (i) 0-3 months (n = 18), (ii) 12-36 months (n = 55), and (iii) ≥48 months (n = 83). The prevalence of atherosclerotic characteristics such as eccentric plaques, calcification, and lipid pools increased from 6, 0, and 6% in group 1 to 78, 42, and 61% in group 3, respectively (all P < 0.001). The prevalence of vulnerable plaque features such as thin-cap fibroatheroma, macrophages, and microchannels increased from 0% in group 1 to 12, 29, and 33% in group 3, respectively (P = 0.19, P = 0.006, and P = 0.003). Complicated coronary lesions such as intimal laceration, intraluminal thrombus, and layered complex plaque increased from 0% in group 1 to 18, 19, and 57% in group 3 (P = 0.009, P < 0.001, and P < 0.001). Plaque rupture was identified in 4% of group 3 segments.
CONCLUSION: The current study gives new insight into CAV that extends far beyond the current concept of concentric and fibrosing vasculopathy, that is, the development of atherosclerosis with vulnerable plaque and complicated coronary lesions.
Authors:
Andrew Cassar; Yoshiki Matsuo; Joerg Herrmann; Jing Li; Ryan J Lennon; Rajiv Gulati; Lilach O Lerman; Sudhir S Kushwaha; Amir Lerman
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural     Date:  2013-06-25
Journal Detail:
Title:  European heart journal     Volume:  34     ISSN:  1522-9645     ISO Abbreviation:  Eur. Heart J.     Publication Date:  2013 Sep 
Date Detail:
Created Date:  2013-09-02     Completed Date:  2014-03-18     Revised Date:  2014-09-02    
Medline Journal Info:
Nlm Unique ID:  8006263     Medline TA:  Eur Heart J     Country:  England    
Other Details:
Languages:  eng     Pagination:  2610-7     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Allografts
Coronary Artery Disease / pathology*
Female
Heart Transplantation*
Humans
Male
Middle Aged
Plaque, Atherosclerotic / pathology
Postoperative Complications / pathology*
Prospective Studies
Tomography, Optical Coherence
Ultrasonography, Interventional
Vascular Calcification / pathology
Grant Support
ID/Acronym/Agency:
AG31750/AG/NIA NIH HHS; HL085307/HL/NHLBI NIH HHS; HL77131/HL/NHLBI NIH HHS; HL92954/HL/NHLBI NIH HHS
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