Related Experiment Video
Updated: Jul 30, 2025
Author Spotlight: Enhancing Graft Viability Assessment Through Quantitative Metrics and Innovative Reservoir Systems
Published on: August 2, 2024
Fibrotic Plaque and Microvascular Dysfunction Predict Early Cardiac Allograft Vasculopathy Progression After Heart
Sharon Chih1, Aun Yeong Chong2, Vladimír Džavík3
1Heart Failure and Transplantation (S.C., E.S., L.M.M.), Division of Cardiology, University of Ottawa Heart Institute, ON, Canada.
Insights
Early identification of cardiac allograft vasculopathy (CAV) is crucial for heart transplant recipients. Fibrotic plaque and microvascular dysfunction in the first year predict CAV progression, guiding early intervention strategies.
Area of Science:
- Cardiology
- Transplantation Immunology
- Vascular Biology
Background:
- Cardiac allograft vasculopathy (CAV) impacts long-term heart transplant outcomes.
- Early prognostication of CAV is essential for patient management.
- Characterizing early post-transplant coronary changes can identify progression predictors.
Purpose of the Study:
- To identify predictors of early cardiac allograft vasculopathy (CAV) progression.
- To characterize coronary anatomic-physiologic alterations within the first year post-heart transplantation.
- To establish early markers for improved long-term heart transplant outcomes.
Main Methods:
- Prospective evaluation of 82 heart transplant recipients at 3 and 12 months post-transplant.
- Utilized angiography, intravascular ultrasound, optical coherence tomography, and coronary physiology assessments.
- Assessed CAV progression via intravascular ultrasound change in percentage intimal volume.
Main Results:
- Donor atherosclerosis was present in 50% at baseline.
- De novo or rapidly progressive CAV developed in 24% and 13% of patients, respectively.
- Fibrotic plaque increased from 29% to 50%; microvascular dysfunction (IMR ≥25) was seen in 20% of patients. Recipient male sex, fibrotic plaque, and IMR independently predicted coronary disease progression.
Conclusions:
- Fibrotic plaque identified by optical coherence tomography predicts CAV progression.
- Index of microcirculatory resistance (IMR) early post-transplant is a predictor of CAV progression.
- These markers can aid in early prognostication and management of CAV.
Background:
Early cardiac allograft vasculopathy (CAV) prognostication is needed to improve long-term outcomes after heart transplantation. We characterized first year posttransplant coronary anatomic-physiologic alterations to determine predictors of early CAV progression.
Methods:
Heart transplant recipients at 2 institutions (enrolled January 2018 to March 2021) underwent prospective evaluation 3 and 12-month posttransplant with angiography and left anterior descending artery intravascular ultrasound, optical coherence tomography, fractional flow reserve, coronary flow reserve, and index of microcirculatory resistance measurements. CAV progression was assessed by intravascular ultrasound change in percentage intimal volume from baseline to 12-month follow-up.
Results:
Eighty-two patients (mean age, 51 years; 60% men) completed evaluation at mean 13.8 and 56.3 weeks posttransplant. Donor atherosclerosis (baseline intravascular ultrasound maximal intimal thickness, ≥0.5 mm) was evident in 50%. De novo (follow-up maximal intimal thickness, ≥0.5 mm) and rapidly progressive CAV (maximal intimal thickness, ≥0.5-mm increase from baseline) developed in 24% and 13%, respectively. On optical coherence tomography, baseline to follow-up median intimal volume increased 42% (0.58 mm3/mm), percentage intimal volume increased 44% (4.6%), vessel volume decreased 4% (-0.50 mm3/mm) and lumen volume decreased 9% (-1.02 mm3/mm); P<0.05 for all. Fibrotic plaque was the predominant morphology: baseline, 29% and follow-up, 50%. Coronary physiology was abnormal in 41% at baseline and 45% at follow-up, with 1 in 5 patients having microvascular dysfunction (index of microcirculatory resistance, ≥25). On multivariable linear regression analysis, recipient male sex, fibrotic plaque, and index of microcirculatory resistance were independent predictors of coronary disease progression.
Conclusions:
Fibrotic plaque on optical coherence tomography and index of microcirculatory resistance early posttransplant predict CAV progression in the first year of transplantation.
Registration:
URL: https://www.
Clinicaltrials:
gov; Unique identifier: NCT03217786.
