Analysis of Fibrotic Plaques in Angiographic Manifest Cardiac Allograft Vasculopathy in Long-term Heart Transplanted Patients Using Optical Coherence Tomography

Abstract

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Diagnosis of CAV in OCT Scans From Heart Transplanted Patients

“…Omeed Neghabat, MD, 1,2 and Niels Ramsing Holm, MD 1,2 I t is with great interest that we read the present article by…”

“…In Figure 1 by Orban et al, 1 the authors demonstrate a representation of different OCT findings. Although the figure illustrates common findings in a HTx population, we disagree on the representation of lipid plaque in Figure 1C by Orban et al 1 According to international consensus, a lipid plaque is characterized by signal-poor, diffusely delineated regions with high attenuation and low light penetration depth, and the plaque is located within the intimal layer of the vessel. 3 The presented image in Figure 1C by Orban et al 1 deviates from the above on several essential points as presented in Figure 1.…”

“…Orban et al 1 regarding atherosclerotic plaques in long-term heart transplanted (HTx) patients. We find the use of optical coherence tomography (OCT) in detection of cardiac allograft vasculopathy (CAV) intriguing, as the sole use of coronary angiography is encumbered with a high degree of ambiguity and low sensitivity for CAV when compared with OCT. 2 We realize that images in publications might not reflect the applied analysis, but the authors' interpretation of essential findings in the presented OCT scans is a matter of concern.…”

“…FIGURE 1. This image is borrowed from the present study by Orban et al1 We have inserted colored areas for explanation. Red area: homogeneous tissue with low attenuation indicative of organized thrombus inside the vessel.…”

Letter to the Editor. Response to “Diagnosis of CAV in OCT Scans From Heart Transplanted Patients”

“…We appreciate the interest of Neghabat and Holm 1 in our recently published study and are open to the discussion of the important topic of cardiac allograft vasculopathy (CAV). 2 Assessment of the different patterns of CAV with optical coherence tomography (OCT) is a relatively new approach to gain deeper insight into this important vascular pathology. Although we completely agree that the diagnosis of an organized thrombus must be considered when evaluating CAV findings in OCT, we can confirm that according to current consensus definitions and the best of our knowledge, the previously shown OCT frame (Figure 1C in the previous article) is part of a lipid plaque.…”