OBJECTIVES: This study was designed to investigate tissue characterization of the coronary allograft atherosclerotic plaque with virtual histology intravascular ultrasound (VH-IVUS) imaging to assess the presence and predictors of vessel wall inflammation and its significance in cardiac allograft vasculopathy (CAV) progression. BACKGROUND: A unique form of accelerated atherosclerosis, CAV remains the leading cause of late morbidity and mortality in heart transplant patients. The pathogenesis of CAV is not fully elucidated. METHODS: A total of 86 patients with coronary allograft vasculopathy underwent VH-IVUS examination of the left anterior descending coronary artery 3.61 +/- 3.04 years following cardiac transplantation. Based on the VH-IVUS plaque characteristics, coronary allograft plaque was divided on virtual histology intravascular ultrasound-derived "inflammatory" (VHD-IP) (necrotic core and dense calcium > or =30%) and "noninflammatory" plaque (VHD-NIP) (necrotic core and dense calcium <30%). Total rejection scores were calculated based on the 2004 International Society of Heart and Lung Transplantation rejection grading system. RESULTS: In the whole study population, the mean percentage of fibrous, fibrofatty, dense calcified, and necrotic core plaques in a mean length of 62.3 +/- 17.4 mm of the left anterior descending coronary artery were 50 +/- 17%, 16 +/- 11%, 15 +/- 11%, and 18 +/- 9%, respectively. Patients with a 6-month total rejection score >0.3 had significantly higher incidence of VHD-IP than those with a 6-month total rejection score < or =0.3 (69% vs. 33%, p = 0.011). The presence of VHD-IP at baseline was associated with a significant increase in plaque volume (2.42 +/- 1.78 mm(3)/mm vs. -0.11 +/- 1.65 mm(3)/mm, p = 0.010), plaque index (7 +/- 9% vs. 0 +/- 8%, p = 0.04), and remodeling index (1.24 +/- 0.44 vs. 1.09 +/- 0.36, p = 0.030) during 12 months of follow-up when compared with the presence of VHD-NIP at baseline and during follow-up. CONCLUSIONS: The presence of VHD-IP as assessed by VH-IVUS is associated with early recurrent rejection and with higher subsequent progression of CAV. A VH-IVUS assessment may add important information in the evaluation of transplant recipients.
OBJECTIVES: This study was designed to investigate tissue characterization of the coronary allograft atherosclerotic plaque with virtual histology intravascular ultrasound (VH-IVUS) imaging to assess the presence and predictors of vessel wall inflammation and its significance in cardiac allograft vasculopathy (CAV) progression. BACKGROUND: A unique form of accelerated atherosclerosis, CAV remains the leading cause of late morbidity and mortality in heart transplant patients. The pathogenesis of CAV is not fully elucidated. METHODS: A total of 86 patients with coronary allograft vasculopathy underwent VH-IVUS examination of the left anterior descending coronary artery 3.61 +/- 3.04 years following cardiac transplantation. Based on the VH-IVUS plaque characteristics, coronary allograft plaque was divided on virtual histology intravascular ultrasound-derived "inflammatory" (VHD-IP) (necrotic core and dense calcium > or =30%) and "noninflammatory" plaque (VHD-NIP) (necrotic core and dense calcium <30%). Total rejection scores were calculated based on the 2004 International Society of Heart and Lung Transplantation rejection grading system. RESULTS: In the whole study population, the mean percentage of fibrous, fibrofatty, dense calcified, and necrotic core plaques in a mean length of 62.3 +/- 17.4 mm of the left anterior descending coronary artery were 50 +/- 17%, 16 +/- 11%, 15 +/- 11%, and 18 +/- 9%, respectively. Patients with a 6-month total rejection score >0.3 had significantly higher incidence of VHD-IP than those with a 6-month total rejection score < or =0.3 (69% vs. 33%, p = 0.011). The presence of VHD-IP at baseline was associated with a significant increase in plaque volume (2.42 +/- 1.78 mm(3)/mm vs. -0.11 +/- 1.65 mm(3)/mm, p = 0.010), plaque index (7 +/- 9% vs. 0 +/- 8%, p = 0.04), and remodeling index (1.24 +/- 0.44 vs. 1.09 +/- 0.36, p = 0.030) during 12 months of follow-up when compared with the presence of VHD-NIP at baseline and during follow-up. CONCLUSIONS: The presence of VHD-IP as assessed by VH-IVUS is associated with early recurrent rejection and with higher subsequent progression of CAV. A VH-IVUS assessment may add important information in the evaluation of transplant recipients.
Authors: Bo Zheng; Akiko Maehara; Gary S Mintz; Tamim M Nazif; Yarden Waksman; Fuyu Qiu; Luz Jaquez; LeRoy E Rabbani; Mark A Apfelbaum; Ziad A Ali; Kate Dalton; Lei Song; Ke Xu; Charles C Marboe; Donna M Mancini; Giora Weisz Journal: Int J Cardiovasc Imaging Date: 2015-09-25 Impact factor: 2.357
Authors: Chelsey L King; Jennifer J Devitt; Timothy D G Lee; Camille L Hancock Friesen Journal: J Cardiothorac Surg Date: 2010-06-22 Impact factor: 1.637
Authors: Kozo Okada; William F Fearon; Helen Luikart; Hideki Kitahara; Kyuhachi Otagiri; Shigemitsu Tanaka; Takumi Kimura; Paul G Yock; Peter J Fitzgerald; Alan C Yeung; Hannah A Valantine; Kiran K Khush; Yasuhiro Honda Journal: J Am Coll Cardiol Date: 2016-07-26 Impact factor: 24.094
Authors: Tomoko S Kato; Faisal H Cheema; Jonathan Yang; Yumeko Kawano; Hiroo Takayama; Yoshifumi Naka; Maryjane Farr; David J Lederer; Matthew R Baldwin; Zhezhen Jin; Shunichi Homma; Donna M Mancini; P Christian Schulze Journal: Circ Heart Fail Date: 2013-05-14 Impact factor: 8.790