Clinical Implications of Intracoronary Imaging in Cardiac Allograft Vasculopathy

Guddeti, Raviteja; Matsuo, Yoshiki; Matsuzawa, Yasushi; Aoki, Tatsuo; Lerman, Lilach O.; Kushwaha, Sudhir S.; Lerman, Amir

doi:10.1161/circimaging.114.002636

Cited by 34 publications

(17 citation statements)

References 59 publications

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“…4 The presence of intimal thickening by IVUS has been shown to be predictive of future clinical events. [5][6][7][8][9][10] Rapidly progressive CAV (as defined by an increase in maximal intimal thickness (MIT) by 0.5 mm within the first year is associated with increased mortality and myocardial infarction when compared to a lesser degree of thickening. 11 Sirolimus and everolimus are proliferation signal inhibitors (PSI) that are associated with reduction of CAV incidence and progression in randomized controlled trials.…”

Section: Introductionmentioning

confidence: 99%

Risk factors for early development of cardiac allograft vasculopathy by intravascular ultrasound

Moayedi

Fan

Tremblay-Gravel

et al. 2020

Clinical Transplantation

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Background: Cardiac allograft vasculopathy (CAV) is the leading cause of late graft loss. While there are numerous post-transplant factors which may increase the risk of the development of CAV, there is a paucity of data on the impact of donor-derived atherosclerosis (DA), early discontinuation of prednisone, and early initiation of proliferation signal inhibitors (PSI) as assessed by intravascular ultrasound (IVUS). Methods: Retrospective single-center study of all adult transplant patients (2008-2017) with serial IVUS at baseline and annually for 5 years. DA was defined as a baseline maximal intimal thickness (MIT) ≥0.5 mm, and CAV development was defined as MIT ≥1 mm or an increase in MIT ≥0.5 mm at year 1 compared with baseline or an increase in 0.3 mm annually thereafter. Clinical risk factors for CAV were identified using multivariable hazard regression. Separate multistate models were applied to assess the association of prednisone discontinuation and PSI initiation and CAV. Results: Of 282 patients screened, 186 patients had a 1-year angiogram. The mean age of those included in the cohort was 51 ± 11 years, 70% were male, 58% were Caucasian, and 27% were supported by a left ventricular assist device. Donor atherosclerosis was present in 40%. The cumulative incidence of CAV at 5 years is 41% in DA-vs. 59% in DA + (p = .012). Donor age was a strong predictor of DA (p = .016). Significant risk factors for CAV included male sex (HR = 4.141, p = .001), non-Caucasian race (HR = 1.98, p = .011), BMI < 18 kg/m2 (HR = 4.596, p = .042), longer ischemic time (HR = 1.374, p = .028), older donor age (HR = 1.158, p = .009), and rejection with hemodynamic compromise within the first year (HR = 2.858, p = .043).

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Section: Introductionmentioning

confidence: 99%

Risk factors for early development of cardiac allograft vasculopathy by intravascular ultrasound

Moayedi

Fan

Tremblay-Gravel

et al. 2020

Clinical Transplantation

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“…Due to a lower tissue penetration, OCT is limited in determining the plaque burden, vessel size based on the detection of the external elastic membrane (EEM) at the minimal lumen diameter, which is one of the parameters used for IVUSguided stent sizing (14). The majority of previous IVUS studies reportedly applied the multicenter ultrasound stenting in coronary (MUSIC) criteria (Table 1) (15) with the key criteria of an in-stent minimal lumen area ≥80% of the average reference lumen area or ≥90% of the lumen area of the reference segment with the lower lumen size along with symmetric stent expansion.…”

Section: What Was Known Before Ilumienmentioning

confidence: 99%

Optical coherence tomography- vs. intravascular ultrasound-guided percutaneous coronary intervention

Räber

Ueki

2017

J. Thorac. Dis.

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Coronary angiography is routinely used to guide percutaneous coronary interventions (PCI) despite obvious limitations of this lumen based approach. Intravascular imaging including intravascular ultrasound (IVUS) and optical coherence tomography (OCT) represent two techniques that provide essential information on preprocedural lesion characteristics (i.e., lesion severity, landing zone, and plaque composition) and the result after stent implantation (i.e., stent expansion and eccentricity, strut apposition, lesion coverage, tissue protrusion, and dissections). A total of 11 randomized controlled trials investigated the effect of IVUS-guided PCI with mixed results (1-11). Of note, studies including patients with an increased complexity [i.e., chronic total occlusion (CTO) or lesion length >28 mm] demonstrated a consistent benefit of IVUS-guided PCI as compared with angiography, mainly driven by a reduction of repeat revascularization for restenosis (MACE at 1 year: CTO-IVUS, 2.6% vs. 7.1%, P=0.035; IVUS-XPL, 2.9% vs. 5.8%, P=0.007) (1,2). In addition, IVUS was instrumental in guiding left main stem PCI in the recent EXCEL and NOBLE left main trials in more than 70% of patients, although these studies were not designed to investigate effects of intracoronary-guided imaging (12,13).OCT has a high spatial resolutions of 10-20 µm, which is approximately 10 times greater as compared with IVUS. Due to a lower tissue penetration, OCT is limited in determining the plaque burden, vessel size based on the detection of the external elastic membrane (EEM) at the minimal lumen diameter, which is one of the parameters used for IVUSguided stent sizing (14). The majority of previous IVUS studies reportedly applied the multicenter ultrasound stenting in coronary (MUSIC) criteria (Table 1) (15) with the key criteria of an in-stent minimal lumen area ≥80% of the average reference lumen area or ≥90% of the lumen area of the reference segment with the lower lumen size along with symmetric stent expansion. Notwithstanding the increasing use of OCT for PCI-guidance, standard criteria for this light-based technology have not been established.To date, the use of OCT for guiding PCI has mainly been evaluated in smaller studies, using surrogate marker endpoints (16,17). In the recent DOCTORS trial, the use of OCT-guided PCI was associated with a small but significant difference in post-procedural FFR (0.94±0.04 vs. 0.92±0.05, P=0.005) (18). In the OCTACS study, OCTguidance resulted in a lower proportion of uncovered struts at 6 months (4.3% vs. 9.0%, P<0.01) (19).Based on the well-established and currently still widespread clinical use of IVUS-guided PCI and the available aforementioned evidence on its effectiveness, one of the key questions is whether OCT-guided PCI using a specific protocol is comparable to IVUS-guided PCI in terms of lesion expansion. ILUMIEN 3 (20) was designed to fill this gap of clinically relevant evidence.

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“…Conventional angiography is the accepted gold standard for evaluating pediatric heart transplant recipients for CAV . Yet, angiography has poor sensitivity to detect early structural changes in the coronary arteries because it can only identify the narrowing of the lumen . Given that CAV begins with a process of progressive intimal thickening these occult diffuse changes may be missed with the current standard diagnostic approach.…”

Section: Introductionmentioning

confidence: 99%

“…the coronary arteries because it can only identify the narrowing of the lumen. 8 Given that CAV begins with a process of progressive intimal thickening these occult diffuse changes may be missed with the current standard diagnostic approach. In an effort to improve early detection of CAV, intravascular imaging modalities have been used recently in heart transplant recipients.…”

mentioning

confidence: 99%

Coronary artery intimal thickening and ventricular dynamics in pediatric heart transplant recipients

Coté

Hosking

Voss

et al. 2018

Congenital Heart Disease

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Clinical Implications of Intracoronary Imaging in Cardiac Allograft Vasculopathy

Cited by 34 publications

References 59 publications

Risk factors for early development of cardiac allograft vasculopathy by intravascular ultrasound

Risk factors for early development of cardiac allograft vasculopathy by intravascular ultrasound

Optical coherence tomography- vs. intravascular ultrasound-guided percutaneous coronary intervention

Coronary artery intimal thickening and ventricular dynamics in pediatric heart transplant recipients

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