- Email: [email protected]
OPTICAL COHERENT TOMOGRAPHY EVALUATION OF TRANSPLANT CORONARY ARTERY VASCULOPATHY WITH AND WITHOUT HISTORY OF CELLULAR REJECTION
E1758 JACC March 12, 2013 Volume 61, Issue 10
TCT@ACC-i2: Invasive and Interventional Cardiology Optical Coherent Tomography Evaluation of Transplant Coronary Artery Vasculopathy with and without History of Cellular Rejection Oral Contributions West, Room 2004 Sunday, March 10, 2013, 8:45 a.m.-8:55 a.m.
Session Title: Intravascular Imaging and Physiologic Assessment Abstract Category: 38. TCT@ACC-i2: Intravascular Imaging and Physiology Presentation Number: 2907-7 Authors: Liang Dong, Ari T. Pollack, Nazif Tamim, Donna Mancini, Ulrich Jorde, Gary Mintz, Akiko Maehara, Giora Weisz, Cardiovascular Research Foundation, New York, NY, USA Background: Cardiac allograft vasculopathy may result from ‘standard’ atherosclerosis and/or transplant related allograft changes with diffuse involvement. Method: At routine annual follow-up angiogram, 37 transplant pts underwent OCT imaging of coronary artery. % intimal area was calculated as intimal divided by external elastic membrane area. Plaque with attenuation was defined a plaque with a fast signal drop off presumably indicating lipidic plaque or macrophages. Result: Pt age at transplantation was 31±11 yrs and 31 (84%) were male. The reason for transplantation was coronary artery disease in 13 (35%), and the time from transplantation to OCT imaging was 6.1±4.5 yrs. Ten pts had a prior history of international Society for Heart and Lung Transplantation (ISHLT) 3A rejection. %intimal area was significantly greater in the distal, mid, and proximal segments in the rejection group compared to the non-rejection group along with an increase maximum intimal thickness and more frequent plaque with attenuation in the mid and distal, but not the proximal segments (Table). Conclusion: Pts with an history of ISHLT rejection of at least 3A have increased coronary intimal thickness and area, and higher percentage of plaque with attenuation as compared to pts without prior rejection. Diffuse intimal thickening with lipidic plaque, especially at the mid and distal segment, may indicate allograft vasculopathy rather than standard atherosclerotic changes that occur in proximal segments. Table Distal segment Lumen area (mm2) %Intimal area (%) Max intimal thickness (µm) Plaque with attenuation Mid segment Lumen area (mm2) %Intimal area Max intimal thickness (µm) Plaque with attenuation Proximal segment Lumen area (mm2) %Intimal area (%) Max intimal thickness (µm) Plaque with attenuation
Rejection History Group (n=10)
No Rejection Group (n=27)
p-value
5.2±2.6 27.4±5.1 425±376 40% (4)
6.6±3.9 12.9±9.3 230±203 12% (3)
0.32 0.002 0.055 0.16
7.1±0.9 28.8±12.8 554±253 70% (7)
8.3±3.0 16.3±12.6 307±257 19% (5)
0.31 0.015 0.018 0.007
10.7±4.4 24.2±9.3 529±189 44% (4)
12.7±4.1 15.6±10.4 410±367 23% (5)
0.24 0.040 0.37 0.38
TCT@ACC-i2: Invasive and Interventional Cardiology Optical Coherent Tomography Evaluation of Transplant Coronary Artery Vasculopathy with and without History of Cellular Rejection Oral Contributions West, Room 2004 Sunday, March 10, 2013, 8:45 a.m.-8:55 a.m.
Session Title: Intravascular Imaging and Physiologic Assessment Abstract Category: 38. TCT@ACC-i2: Intravascular Imaging and Physiology Presentation Number: 2907-7 Authors: Liang Dong, Ari T. Pollack, Nazif Tamim, Donna Mancini, Ulrich Jorde, Gary Mintz, Akiko Maehara, Giora Weisz, Cardiovascular Research Foundation, New York, NY, USA Background: Cardiac allograft vasculopathy may result from ‘standard’ atherosclerosis and/or transplant related allograft changes with diffuse involvement. Method: At routine annual follow-up angiogram, 37 transplant pts underwent OCT imaging of coronary artery. % intimal area was calculated as intimal divided by external elastic membrane area. Plaque with attenuation was defined a plaque with a fast signal drop off presumably indicating lipidic plaque or macrophages. Result: Pt age at transplantation was 31±11 yrs and 31 (84%) were male. The reason for transplantation was coronary artery disease in 13 (35%), and the time from transplantation to OCT imaging was 6.1±4.5 yrs. Ten pts had a prior history of international Society for Heart and Lung Transplantation (ISHLT) 3A rejection. %intimal area was significantly greater in the distal, mid, and proximal segments in the rejection group compared to the non-rejection group along with an increase maximum intimal thickness and more frequent plaque with attenuation in the mid and distal, but not the proximal segments (Table). Conclusion: Pts with an history of ISHLT rejection of at least 3A have increased coronary intimal thickness and area, and higher percentage of plaque with attenuation as compared to pts without prior rejection. Diffuse intimal thickening with lipidic plaque, especially at the mid and distal segment, may indicate allograft vasculopathy rather than standard atherosclerotic changes that occur in proximal segments. Table Distal segment Lumen area (mm2) %Intimal area (%) Max intimal thickness (µm) Plaque with attenuation Mid segment Lumen area (mm2) %Intimal area Max intimal thickness (µm) Plaque with attenuation Proximal segment Lumen area (mm2) %Intimal area (%) Max intimal thickness (µm) Plaque with attenuation
Rejection History Group (n=10)
No Rejection Group (n=27)
p-value
5.2±2.6 27.4±5.1 425±376 40% (4)
6.6±3.9 12.9±9.3 230±203 12% (3)
0.32 0.002 0.055 0.16
7.1±0.9 28.8±12.8 554±253 70% (7)
8.3±3.0 16.3±12.6 307±257 19% (5)
0.31 0.015 0.018 0.007
10.7±4.4 24.2±9.3 529±189 44% (4)
12.7±4.1 15.6±10.4 410±367 23% (5)
0.24 0.040 0.37 0.38