Cardiac allograft vasculopathy in heart transplanted recipients: The multivessel study

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.

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.

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.

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.