Optical Coherence Tomography for the Early Detection of Coronary Vascular Changes in Children and Adolescents After Cardiac Transplantation

McGovern, Eiméar; Hosking, Martin; Balbacid, Enrique; Voss, Christine; Berger, Felix; Schubert, Stephan; Harris, Kevin C.

doi:10.1016/j.jcmg.2018.04.025

Cited by 25 publications

(34 citation statements)

References 25 publications

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“…Previous studies showed that excessive intimal thickening is the first step in coronary pre-atherosclerosis, preceding lipid deposition [ 31 – 33 ]. Indetectable but important, therefore, the IMR has been widely used for evaluating the severity of intimal hyperplasia [ 13 , 14 , 34 , 35 ].…”

Section: Discussionmentioning

confidence: 99%

Assessment of radial artery atherosclerosis in acute coronary syndrome patients: an in vivo study using optical coherence tomography

Tang

Wang

et al. 2022

BMC Cardiovasc Disord

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Background Radial artery (RA) atherosclerosis in acute coronary syndrome (ACS) patients has not been systematically observed in vivo. The study aims to characterize plaque morphology and intimal hyperplasia of the RA in patients with ACS, using optical coherence tomography (OCT). Methods In this retrospective study involving 239 ACS patients underwent RA OCT without guidewire shadow, 3 groups were divided according to the following criteria: radial artery plaque (RAP) group included patients with fibrous, lipid or calcified plaque; patients without RAP were further classified into radial intimal hyperplasia (RIH) group (intima media thickness ratio [IMR] ≥ 1) or normal group (IMR < 1). The presence and characteristics of RAP and its related risk factors were identified. Results The RAP, RIH and normal groups included 76 (31.8%), 69 (28.9%) and 94 (39.3%) patients, respectively. Patients in RAP group were the oldest, compared with those in the RIH and normal groups (p < 0.001), and more frequently had triple vessel disease (p = 0.004). The percentage of plaque rupture (72.4% vs. 56.4%, p = 0.018) and calcification (42.1% vs. 27.6%, p = 0.026) at culprit lesion were significantly higher in patients with RAP than those without RAP. A total of 148 RAP were revealed by OCT, including fibrous (72, 48.6%), lipid (50, 33.8%) and calcified plaques (26, 17.6%). The microvessels were also frequently observed in the RAP group than that in RIH and normal groups (59.2% vs. 8.7% vs. 9.6%, p < 0.001). Multivariate logistic regression analysis showed that age, diabetes, and smoking history (all p < 0.05) were independent risk factors for RAP. Conclusions In terms of insights gained from OCT, RA atherosclerosis is not uncommon in ACS patients by OCT, sharing several morphological characters with early coronary atherosclerosis. Aging, diabetes, and smoking are risk factors for RAP.

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Section: Discussionmentioning

confidence: 99%

Assessment of radial artery atherosclerosis in acute coronary syndrome patients: an in vivo study using optical coherence tomography

Tang

Wang

et al. 2022

BMC Cardiovasc Disord

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“…The OCT images were analysed as previously described. 29 For each pullback, digital planimetry of nine cross-sectional frames at least 1 mm apart was performed. Intimal thickness was determined, and the I/M CSA ratios were calculated (Figure 1).…”

Section: Cavmentioning

confidence: 99%

Long‐term experience using CNI‐free immunosuppression in selected paediatric heart transplant recipients

Rosenthal

Nordmeyer

Krämer

et al. 2021

Pediatric Transplantation

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Background: CNI-free immunosuppression with conversion to mTORi-based immunosuppression has been demonstrated to reduce CNI-toxicity and to exhibit antiproliferative properties. However, the experience of CNI-free immunosuppression in paediatric heart transplantation is limited. Methods: A retrospective analysis was conducted of 129 paediatric heart transplants performed between 1997 and 2015. Fifteen patients with clinically indicated conversion from CNI-based to CNI-free immunosuppression were identified. Survival data, rejection episodes, renal function, post-transplantation lymphoproliferative disorder and CAV, including examination with OCT were analysed. Results: Immunosuppression conversion was successful in all patients. Fourteen of 15 patients (93%) are currently living with good graft function. Median post-transplant survival was 15 years (range, 5-23 years), and median follow-up since conversion was 6 years (range, 1-11 years). Mild (grade 1R) ACR was present in three patients after discontinuation of CNIs. The recovery of renal function with a significant increase in eGFR was observed at 1 and 3 years after conversion. No patient had angiographic signs of macroscopic CAV according to the current ISHLT classification; however, OCT showed the signs of angiographically silent CAV in all patients. CAV did not progress in any patient, implying CAV was stabilised by mTORi-based CNI-free immunosuppression.Conclusions: CNI-free immunosuppression based on mTORis is a safe and appropriate strategy for maintenance therapy in selected paediatric patients, significantly improves renal function and stabilises CAV. OCT revealed early development of angiographically silent CAV.

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“…This recommendation has increasingly led to using intravascular imaging techniques such as OCT to supplement the information obtained from conventional coronary angiograms. In pediatric cardiology, there has been increasing interest in the use of OCT for evaluating coronary anatomy in patients with Kawasaki disease and post–heart transplantation ( 7 , 8 , 9 ). Our case shows the potential for using OCT as an adjunct to conventional cardiac imaging for surveillance of coronary stents in pediatric patients.…”

Section: Question 3: How Should Coronary Stents Be Monitored For Stent Failure In Pediatric Patients?mentioning

confidence: 99%

Oct

et al. 2021

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We present the case of a 16-year-old patient with anomalous left coronary artery from the left pulmonary artery requiring percutaneous coronary intervention in infancy who presented with ventricular fibrillation arrest. A coronary angiogram revealed 40% narrowing of the stent relative to the remainder of the left main coronary artery. Optical coherence tomography was performed and revealed an area stenosis of 70% relative to the native left main coronary artery. The patient had outgrown the stent. ( Level of Difficulty: Advanced. )

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Optical Coherence Tomography for the Early Detection of Coronary Vascular Changes in Children and Adolescents After Cardiac Transplantation

Abstract: OCT provides important insights into coronary vascular changes not detected by angiography in pediatric transplant recipients. The use of OCT for pediatric heart transplant recipients should be further investigated, given its potential to impact the management of CAV.

Cited by 25 publications

References 25 publications

Assessment of radial artery atherosclerosis in acute coronary syndrome patients: an in vivo study using optical coherence tomography

Assessment of radial artery atherosclerosis in acute coronary syndrome patients: an in vivo study using optical coherence tomography

Long‐term experience using CNI‐free immunosuppression in selected paediatric heart transplant recipients

Oct

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