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Patterns of Early Coronary Artery Changes in Pediatric Heart Transplant Recipients Detected Using Optical Coherence
Sabine L Laguë1,2, Jeffrey N Bone3, Rosh Samuel2
1Department of Pediatrics, University of British Columbia, Vancouver, Canada (S.L.L.).
Insights
Optical coherence tomography (OCT) detected early coronary intimal thickening in pediatric heart transplant recipients, often before it was visible on angiography. This finding may allow for earlier intervention to prevent graft failure.
Area of Science:
- Cardiology
- Transplantation immunology
- Medical imaging
Background:
- Cardiac allograft vasculopathy (CAV) is a major cause of graft failure in pediatric heart transplant recipients.
- CAV involves coronary intimal thickening, but standard angiography only detects advanced disease.
- Optical coherence tomography (OCT) offers higher resolution for early detection of vascular changes.
Purpose of the Study:
- To investigate coronary intimal thickening in pediatric heart transplant recipients using OCT.
- To examine the location and nature of intimal thickening.
- To determine if OCT can identify changes preceding overt CAV.
Main Methods:
- Coronary angiography and OCT data were collected from 73 pediatric heart transplant recipients (258 vessel segments).
- Images focused on left anterior descending, left circumflex, and right coronary arteries.
- Intimal thickening was analyzed for location (proximal, middle, distal) and characteristics (segmental/global, eccentric/concentric).
Main Results:
- OCT identified significant intimal thickening in 32 segments, 88% of which were silent on angiography.
- Thickening was predominantly segmental (88%) and equally eccentric (48%) or concentric (52%).
- Prevalence and severity increased with time since transplant and age at transplant/OCT procedure.
Conclusions:
- A high prevalence of segmental and eccentric intimal thickening was observed in pediatric transplant recipients.
- These OCT-identified patterns may precede overt cardiac allograft vasculopathy.
- Early detection of these changes could enable enhanced surveillance and intervention.
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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