Cardiac allograft vasculopathy in heart transplanted recipients: The multivessel study
Niels Møller Jensen, BSc,
Tor Skibsted Clemmensen, MD, PhD, DMSc,
Kamilla Pernille Bjerre, MD, PhD,
Omeed Neghabat, MD,
Lone Juul Hune Mogensen, MStat,
Niels Ramsing Holm, MD,
Jouke Dijkstra, PhD,
Evald Høj Christiansen, MD, PhD,
Steen Hvitfeldt Poulsen, MD, PhD, DMSc,
Hans Eiskjær, MD, PhD, DMSc.
Affiliations
Niels Møller Jensen, BSc
Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Corresponding author: Niels Møller Jensen, BSc, Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
Tor Skibsted Clemmensen, MD, PhD, DMSc
Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
Kamilla Pernille Bjerre, MD, PhD
Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
Omeed Neghabat, MD
Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
Lone Juul Hune Mogensen, MStat
Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
Niels Ramsing Holm, MD
Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
Jouke Dijkstra, PhD
Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
Evald Høj Christiansen, MD, PhD
Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
Steen Hvitfeldt Poulsen, MD, PhD, DMSc
Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
Hans Eiskjær, MD, PhD, DMSc.
Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
Background: Cardiac allograft vasculopathy (CAV) is a prevailing complication following heart transplantation. We aimed to investigate if CAV causes equal vascular remodeling in the major coronary arteries using quantitative optical coherence tomography (OCT) and to explore the prognostic potential of OCT-derived measurements from each coronary artery. Methods: Sixty-four heart transplanted patients had a combined total of 114 full 3-vessel OCTs and coronary angiographies performed between 2013 and 2019. OCT pullbacks were categorized by angiographic CAV classification. Registration of disease progression was censored on July 1, 2022. Results: OCT recordings were classified as follows: no significant CAV, n = 73; mild CAV, n = 18; moderate CAV, n = 13; and severe CAV, n = 10. From intercoronary comparison of severe CAV, we found significant differences by both average lumen/intima ratio (p < 0.0001) and average intima/media ratio (p < 0.0001). The left descending artery (LAD) showed increasingly smaller luminal areas and larger intimal areas within CAV groups compared with the remaining coronary arteries. No differences were seen between major coronary arteries without significant CAV. LAD derived average intima/media ratio (hazard ratio (HR): 3.39; 95% confidence interval (CI): 1.33-8.63; p = 0.01) and average lumen/intima ratio (HR: 2.77; 95% CI: 1.09-7.05; p = 0.03) were the strongest predictors of CAV progression.LAD predictions were superior to predictions based on all 3 coronary arteries. Conclusions: LAD-derived OCT measurements were increasingly affected by CAV compared with the circumflex and right coronary artery. Average lumen/intima and intima/media ratios were the strongest predictors of CAV progression.
