Intravascular ultrasound for cardiac allograft vasculopathy detection
Oscar A Mendiz1, Paul Gamboa1, María F Renedo2,3
1Department of Interventional Cardiology, Cardiology & Cardiovascular Surgery Institute, Buenos Aires, Argentina.
Insights
Intravascular ultrasound (IVUS) reliably detects silent cardiac allograft vasculopathy (CAV) in heart transplant recipients, even when coronary angiography shows no issues. Early IVUS detection of CAV can improve graft survival.
Area of Science:
- Cardiology
- Transplantation Medicine
- Vascular Biology
Background:
- Cardiac allograft vasculopathy (CAV) is a major cause of heart transplant graft loss.
- CAV often presents asymptomatically due to graft denervation, delaying diagnosis.
- Conventional coronary angiography has limitations in detecting early-stage CAV.
Purpose of the Study:
- To compare the efficacy of coronary angiography and intravascular ultrasound (IVUS) in detecting CAV.
- To evaluate IVUS as a tool for identifying angiographically silent CAV.
Main Methods:
- A prospective study included 114 heart transplant patients undergoing both coronary angiography and IVUS.
- Patients were followed for a mean of 87 months.
- Intravascular ultrasound (IVUS) was used to assess intimal thickness and classify CAV severity.
Main Results:
- Coronary angiography identified lesions in only 24% of patients.
- IVUS detected CAV in 100% of patients, with 76.3% classified as ISHLT CAV 0.
- Significant intimal thickening (MIT >0.5 mm) was observed in 52% of vessels assessed by IVUS.
Conclusions:
- Intravascular ultrasound (IVUS) is a safe and reliable adjunct to coronary angiography for detecting angiographically silent CAV.
- Early detection of CAV using IVUS may have significant clinical implications for heart transplant recipients.
- Further multicenter studies are needed to validate these findings and assess the long-term impact of early CAV detection.
Abstract:
Cardiac allograft vasculopathy (CAV) after heart transplantation is a fibro-proliferative process affecting coronary arteries of the graft in up to 46.8% of the cases during the first 10 years post-transplantation. It is one of the main causes of graft loss and death. Due to graft denervation, CAV causing ischemia is usually clinically silent until the disease is far advanced. In this study, we compared coronary angiography with intravascular ultrasound (IVUS) for CAV detection. OUTCOMES: A total of 114 patients with HTx who underwent coronary angiography and IVUS between March 2018 and March 2019 were included. Mean follow-up was 87 ± 61 month. Lesions documented by coronary angiography were found in only 27 (24%) of the 114 patients. IVUS revealed ISHLT CAV 0 in 87 patients (76.3%); ISHLT CAV1 in 15 (13,1%) and ISHLT CAV2 and CAV3 in 6 patients (5.2%) each. Among 328 IVUS images, maximum intimal thickness (MIT) >0.5 mm was obtained in 60 vessels (52%) with 24 patients having three-vessel and 19 two-vessel involvement. CONCLUSION: As an adjunct to conventional coronary angiography to detect angiographically silent CAV in heart transplant patients, IVUS is a reliable and safe technique with a low complication rate. Large multicenter studies are necessary to confirm these findings and the potential long-term clinical impact of early detection in clinically and angiographically silent phase.
