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Long-term temporal trend in plaque eccentricity assessed through intravascular ultrasound imaging after heart
Kai Nogami1, Ilke Ozcan1, Yoshihisa Kanaji2
1Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States of America.
Insights
Cardiac allograft vasculopathy (CAV) plaque progression slows over time after heart transplantation (HTx). Long-term CAV shows more eccentric plaque, similar to atherosclerosis, suggesting similar treatment strategies may be beneficial.
Area of Science:
- Cardiology
- Transplantation Medicine
- Vascular Biology
Background:
- Cardiac allograft vasculopathy (CAV) is a primary cause of graft failure and mortality post-heart transplantation (HTx).
- Conventional understanding of CAV focuses on concentric intimal thickening, but long-term plaque progression patterns remain unclear.
- This study investigates temporal plaque characteristics in CAV using virtual histology intravascular ultrasonography (VH-IVUS).
Purpose of the Study:
- To assess the long-term plaque characteristics and progression patterns in cardiac allograft vasculopathy (CAV) after heart transplantation (HTx).
- To analyze changes in plaque volume and eccentricity over time using serial VH-IVUS assessments.
Main Methods:
- Serial VH-IVUS assessments were performed on 50 heart transplant recipients at three time points: 0-1 year (A1), 3-5 years (A2), and 7-10 years (A3) post-HTx.
- Eccentricity index (EI) was calculated to quantify plaque distribution.
- VH-IVUS findings were compared between early (A1-A2) and late (A2-A3) timeframes.
Main Results:
- Plaque volume index significantly increased in both early and late phases, but the progression rate was slower in the late phase (2.4% vs 5.8%).
- The eccentricity index (EI) decreased in the early phase and increased in the late phase post-HTx.
- Higher EI change in the late phase correlated with lower fibrous plaque proportion and higher dense calcium content.
Conclusions:
- Cardiac allograft vasculopathy (CAV) exhibits more eccentric plaque progression in the late phase after heart transplantation (HTx).
- The plaque composition in later stages shows a decrease in fibrous plaque and an increase in dense calcium.
- These findings suggest that CAV progression can resemble conventional atherosclerosis, potentially benefiting from similar therapeutic strategies.
Background:
Cardiac allograft vasculopathy (CAV) is a leading cause of graft failure and death after heart transplantation (HTx). Conventionally, CAV is characterized by concentric intimal thickening, however the long-term plaque progression patterns are elusive. This study aimed to assess the plaque characteristics in a temporal manner post-HTx using virtual histology intravascular ultrasonography (VH-IVUS).
Methods:
From 279 patients, we included 50 patients who underwent serial VH-IVUS assessment at three assessment points (A1: 0-1 year, A2: 3-5 years, A3: 7-10 years) post-HTx. Eccentricity index (EI) was defined as (maximum intimal thickness [MIT] - minimum intimal thickness)/MIT and evaluated in 39 patients with significant plaque (MIT > 0.50 mm at the A3). Differences in VH-IVUS findings between timepoints (Early: A1-2 [median 3.0] and Late: A2-3 [median 4.1 years]) were investigated.
Results:
Of 50 patients, age was 51 ± 13 years, 36 (72 %) were males. In both Early and Late, the plaque volume index showed a significant increase, however, the rate of progression was significantly slower in Late (5.8 % vs 2.4 %, p = 0.015). The EI showed decrease in Early, compared to increase in Late (-0.040 vs 0.003, p = 0.036). Patients with higher EI change in Late had significantly lower proportion of fibrous plaque (p = 0.002) and higher dense calcium (p = 0.022) at A3.
Conclusions:
In the Late, HTx patients showed more eccentric plaque progression with lower fibrous plaque composition. These results suggest that typical and conventional atherosclerosis-like plaque progression can also occur in CAV during long-term follow-up, suggesting that treatment strategies based on insights into atherosclerosis may be useful.
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