Early optical coherence tomography evaluation of donor-transmitted atherosclerosis and cardiac allograft vasculopathy : insights from a prospective, single-center study
Copyright © 2023 International Society for the Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved..
BACKGROUND: The impact of donor transmitted atherosclerosis as assessed by intravascular ultrasound on development and progression of cardiac allograft vasculopathy (CAV) after heart transplantation (HT) remains poorly defined in contemporary practice. In this exploratory analysis, we sought to assess the prognostic role of early qualitative assessment of donor artery morphology using optical coherence tomography (OCT) as a more sensitive imaging modality.
METHODS: HT recipients were prospectively enrolled for baseline OCT imaging of the left anterior descending coronary artery. OCT findings were classified as normal, homogeneous intimal thickening, and advanced plaque characteristics. The endpoint was a composite of cardiac death, myocardial infarction, or new angiographically detectable CAV stratified by the International Society of Heart and Lung Transplantation criteria up to 4 years of follow-up.
RESULTS: A total of 35 patients underwent baseline OCT of whom 51.4% had normal OCT, 14.3% had homogenous plaque, and 34.3% had advanced characteristics. There were no significant differences in baseline demographics between patients with and without normal morphology. During a mean follow-up of 3.3 ± 0.4 years, the endpoint occurred in 11 patients including 1 death, 7 CAV1, 3 CAV2, and 1 CAV3. Kaplan-Meier analysis revealed a significantly higher event rate in patients with advanced characteristics (log-rank p = 0.010). In multivariate analysis, OCT-based plaque morphology was an independent predictor of clinical events (adjusted hazard ratio 4.57, 95% confidence interval 1.50-13.92, p = 0.008) while maximal intimal thickness ≥0.5 mm was not.
CONCLUSIONS: Early qualitative OCT assessment of donor coronary artery morphology appears to be a reliable marker for predicting future cardiovascular events in HT recipients. Our findings warrant more careful study in a larger cohort.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:42 |
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| Enthalten in: |
The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation - 42(2023), 12 vom: 08. Dez., Seite 1678-1687 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Takahashi, Tatsunori [VerfasserIn] |
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| Links: |
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| Themen: |
Cardiac allograft vasculopathy |
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| Anmerkungen: |
Date Completed 13.11.2023 Date Revised 02.01.2024 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1016/j.healun.2023.07.006 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM359554563 |
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| 100 | 1 | |a Takahashi, Tatsunori |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Early optical coherence tomography evaluation of donor-transmitted atherosclerosis and cardiac allograft vasculopathy |b insights from a prospective, single-center study |
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| 500 | |a Date Revised 02.01.2024 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2023 International Society for the Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved. | ||
| 520 | |a BACKGROUND: The impact of donor transmitted atherosclerosis as assessed by intravascular ultrasound on development and progression of cardiac allograft vasculopathy (CAV) after heart transplantation (HT) remains poorly defined in contemporary practice. In this exploratory analysis, we sought to assess the prognostic role of early qualitative assessment of donor artery morphology using optical coherence tomography (OCT) as a more sensitive imaging modality | ||
| 520 | |a METHODS: HT recipients were prospectively enrolled for baseline OCT imaging of the left anterior descending coronary artery. OCT findings were classified as normal, homogeneous intimal thickening, and advanced plaque characteristics. The endpoint was a composite of cardiac death, myocardial infarction, or new angiographically detectable CAV stratified by the International Society of Heart and Lung Transplantation criteria up to 4 years of follow-up | ||
| 520 | |a RESULTS: A total of 35 patients underwent baseline OCT of whom 51.4% had normal OCT, 14.3% had homogenous plaque, and 34.3% had advanced characteristics. There were no significant differences in baseline demographics between patients with and without normal morphology. During a mean follow-up of 3.3 ± 0.4 years, the endpoint occurred in 11 patients including 1 death, 7 CAV1, 3 CAV2, and 1 CAV3. Kaplan-Meier analysis revealed a significantly higher event rate in patients with advanced characteristics (log-rank p = 0.010). In multivariate analysis, OCT-based plaque morphology was an independent predictor of clinical events (adjusted hazard ratio 4.57, 95% confidence interval 1.50-13.92, p = 0.008) while maximal intimal thickness ≥0.5 mm was not | ||
| 520 | |a CONCLUSIONS: Early qualitative OCT assessment of donor coronary artery morphology appears to be a reliable marker for predicting future cardiovascular events in HT recipients. Our findings warrant more careful study in a larger cohort | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a cardiac allograft vasculopathy | |
| 650 | 4 | |a donor-transmitted atherosclerosis | |
| 650 | 4 | |a heart transplantation | |
| 650 | 4 | |a intravasular ultrasound | |
| 650 | 4 | |a macrophage | |
| 650 | 4 | |a neovascularization | |
| 650 | 4 | |a optical coherence tomography | |
| 700 | 1 | |a Kobayashi, Yuhei |e verfasserin |4 aut | |
| 700 | 1 | |a Saeed, Omar |e verfasserin |4 aut | |
| 700 | 1 | |a Vukelic, Sasha |e verfasserin |4 aut | |
| 700 | 1 | |a Jorde, Ulrich P |e verfasserin |4 aut | |
| 700 | 1 | |a Shin, Jooyoung Julia |e verfasserin |4 aut | |
| 700 | 1 | |a Patel, Snehal R |e verfasserin |4 aut | |
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