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Quantification of Lipid Burden in Heart Transplant (HT) Patients by Near-Infrared Spectroscopy (NIRS)
Abstracts Conclusions: Recipients with no CAV showed an improvement in their endothelial function six months after heart transplantation, compared to recipients with significant CAV. The evolution of peripheral endothelial function in the early post- transplantation period could be a predictor for the development of CAV.
S209 analysis for comparing the IGF1 and IGFBP3 for the CAV and non-CAV matched patients was done. Results: 41 matched CAV and control pairs were analyzed. Average age was 53 ⫾12 years, 83% were male, and 96% were Caucasian. There was no difference in IGF1 and IGFBP3 serum levels between the two groups at baseline (see Table).
565 Quantification of Lipid Burden in Heart Transplant (HT) Patients by Near-Infrared Spectroscopy (NIRS) R.K. Cheng, S. Bhutani, R. Gevorgyan, E. Depasquale, J. Tobis, M.C. Deng, W. Suh. Medicine, Division of Cardiology, UCLA Medical Center, Los Angeles, CA. Purpose: The presence of coronary lipid early post-HT is evidence of donor atherosclerosis. Methods and Materials: 30 HT patients underwent coronary angiography and intravascular ultrasound (IVUS) for TCAD screening from a single institution. They received NIRS as part of the COLOR registry after informed consent. NIRS was analyzed for lipid core burden index (LCBI). Linear regression was used to correlate clinical parameters with LCBI. LCBI was subsequently divided into four groups: r10, 10-49, 50-100, and 4100 and re-analyzed using ordinal regression. Results: Of the 30 patients, 8 were undergoing routine early screening 30-60 days post-HT (median 40.0, IQR 34.0-47.3 days) and 22 were in the intermediate time range 4 60 days (median 406.5, IQR 359.3-732.3 days). 70.6% were male and mean age was 52.5⫾12.8 years. Total cholesterol was 172.7⫾38.0, LDL was 93.3⫾39.5, and HDL was 48.0⫾14.2 mg/dL. 16.7% had angiographic TCAD, with 3 mild (o 20%), 1 moderate (20-70%), and 1 severe (470%) disease. 73.1% had intimal thickening by IVUS and 83.3% had lipid plaque by NIRS. For patients with angiographic TCAD, mean LCBI was 47.6⫾42.2 vs. 26.2⫾37.9 (p¼0.268). For patients with atherosclerosis by IVUS, mean LCBI was 31.6⫾42.1 vs. 14.9⫾17.4 (p¼0.321). In both unadjusted and multivariate regression, there was no correlation of LCBI with recipient age, gender, hypertension, dyslipidemia, tobacco use, diabetes mellitus, white cell count, LDL, HDL, or cylex level. After dividing LCBI into categories, there was also no correlation to any of these factors. Conclusions: The majority of early post-HT patients had lipid burden by NIRS. NIRS appears to be more sensitive than angiography and IVUS in detecting lipid plaque in post-HT patients. The implications of early lipid burden remain unclear post-HT. Longitudinal follow-up is needed to determine if lipid plaque predisposes to development of TCAD. 566 Insulin Growth Factor 1 and Cardiac Allograft Vasculopathy R. Alharethi, S. Knight, O. Galenko, J. Carlquist, B. Horne, D. Budge, S. Frampton, K. Rassmusson, J. Nixon, J. Rollo, K. Brunisholz, A.G. Kfoury. UTAH Cardiac Transplant Program, Intermountain Heart Institute, Salt Lake City, UT. Purpose: Cardiac Allograft Vasculopathy (CAV) is major comorbidity after heart transplantation (OHT) with no definitive therapy besides re-transplantation. Its pathophysiology is not well defined and noninvasive markers of early disease are lacking. Low Insulin Growth Factor 1 (IGF1) and high Insulin Growth Factor Binding protein 3(IGFBP3) have been implicated in the development of atherosclerosis and native coronary artery disease (CAD). The purpose of this study is to evaluate the role of IGF1 and IGFBP3 in CAV. Methods and Materials: The Intermountain Heart Collaborative Study Registry was queried for stored blood samples for heart transplant recipients (1995-2010). IGF1 and IGFBP3 plasma levels were done by ELISA and measured at baseline before the diagnosis of CAV in the CAV group and at similar time points after transplantation in the control group (⫾2 years) which was matched by gender and age. Demographic, clinical and laboratory data were collected at the time of the sample collections. CAV was defined CAV1-3 per International Society for Heart and Lung Transplantation. A non-parametric
CAV(n¼41) DM % HTN % Average IGF1 (ng/ml)⫾std Average IGFBP3 (ng/ml))⫾std
Control (n¼41) P value
7.8 (9.8 48.8 36.6 116.66 ⫾55.73 105⫾39.02
0.69 0.37 0.61
1670.14 ⫾513.28
0.82
1623.75 ⫾1026.93
DM: Diabetes Mellitus, HTN: Hypertension, std: standard deviation Conclusions: Although low serum IGF1 is a risk factor of development of CAD, this association was not found in patients with CAV posttransplant. This observation likely reflects differences in pathophysiology between the two diseases as immunologic process plays a major role in the CAV compare to native atherosclerosis. Larger studies are needed to further explore the role of IGF1 in CAV. 567 Comparison of Optical Coherence Tomography (OCT) and Intravascular Ultrasound (IVUS) for the Early Diagnosis of Cardiac Allograft Vasculopathy in Heart Transplant Patients C.-M. Tissot,1 S. Guendouz,1 G. Mouillet,2 T. Damy,1 J.P. Couetil,3 E. Teiger,2 B. Gellen.1 1Cardiology, Henri Mondor Hospital, Creteil, France; 2Explorations Fonctionnelles, Henri Mondor Hospital, Creteil, France; 3Cardiac Surgery, Henri Mondor Hospital, Creteil, France. Purpose: Cardiac Allograft Vasculopathy (CAV) is one of the leading causes of death after cardiac transplantation. IntraVascular Ultrasound (IVUS) measures the increase in intima-media thickness (IMT) observed in CAV and is more sensitive for diagnosis of CAV than coronary angiography. Optical Coherence Tomography (OCT), a new intracoronary imaging technique, allows more precise measurement of IMT as compared to IVUS. Objective: Demonstrate that OCT is better than IVUS for CAV detection in heart transplant patients. Methods and Materials: Comparison of OCT and IVUS in heart transplant patients with or without angiographic CAV, performed during their systematic follow-up coronary angiography. Results: Among ten heart transplant patients included with a median age of 53.5þ/12 years, 4 had angiographically significant CAV. No major adverse cardiac events occurred during the procedure. Twentytwo coronary arteries, divided into 105 segments, were analysed. IMT measured by IVUS and OCT was comparable (limits of agreement [0.167 – 0.139]). The 4 patients with angiographic CAV had a thicker IMT than healthy patients as defined by IVUS (0.42 ⫾ 0.16 mm et 0.24 ⫾ 0.10 mm respectively, p o 0.001), and by OCT (0.41 ⫾ 0.16 mm and 0.27 ⫾ 0.12, p o 0.001). Only OCT allowed for separate measurement of intima and media. Intimal thickness was significantly increased in patients with CAV (0.28 ⫾ 0.15 mm vs. 0.16 ⫾ 0.09 mm, p o 0.001). Conclusions: OCT and IVUS are both reliable to measure IMT. However, only OCT can evaluate intimal thickening, the key feature of beginning CAV. OCT is therefore a promising tool in the early detection of CAV and may guide adjustment of immunosuppressive treatment aimed at reducing CAV progression. 568 Cardiac Allograft Vasculopathy Is Less Frequent in Contemporary Heart Transplant Population J. Wei, B. Azarbal, R. Cheng, D. Geft, M. Rafiei, J. Patel, L. Czer, J. Kobashigawa. Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA.
S209 analysis for comparing the IGF1 and IGFBP3 for the CAV and non-CAV matched patients was done. Results: 41 matched CAV and control pairs were analyzed. Average age was 53 ⫾12 years, 83% were male, and 96% were Caucasian. There was no difference in IGF1 and IGFBP3 serum levels between the two groups at baseline (see Table).
565 Quantification of Lipid Burden in Heart Transplant (HT) Patients by Near-Infrared Spectroscopy (NIRS) R.K. Cheng, S. Bhutani, R. Gevorgyan, E. Depasquale, J. Tobis, M.C. Deng, W. Suh. Medicine, Division of Cardiology, UCLA Medical Center, Los Angeles, CA. Purpose: The presence of coronary lipid early post-HT is evidence of donor atherosclerosis. Methods and Materials: 30 HT patients underwent coronary angiography and intravascular ultrasound (IVUS) for TCAD screening from a single institution. They received NIRS as part of the COLOR registry after informed consent. NIRS was analyzed for lipid core burden index (LCBI). Linear regression was used to correlate clinical parameters with LCBI. LCBI was subsequently divided into four groups: r10, 10-49, 50-100, and 4100 and re-analyzed using ordinal regression. Results: Of the 30 patients, 8 were undergoing routine early screening 30-60 days post-HT (median 40.0, IQR 34.0-47.3 days) and 22 were in the intermediate time range 4 60 days (median 406.5, IQR 359.3-732.3 days). 70.6% were male and mean age was 52.5⫾12.8 years. Total cholesterol was 172.7⫾38.0, LDL was 93.3⫾39.5, and HDL was 48.0⫾14.2 mg/dL. 16.7% had angiographic TCAD, with 3 mild (o 20%), 1 moderate (20-70%), and 1 severe (470%) disease. 73.1% had intimal thickening by IVUS and 83.3% had lipid plaque by NIRS. For patients with angiographic TCAD, mean LCBI was 47.6⫾42.2 vs. 26.2⫾37.9 (p¼0.268). For patients with atherosclerosis by IVUS, mean LCBI was 31.6⫾42.1 vs. 14.9⫾17.4 (p¼0.321). In both unadjusted and multivariate regression, there was no correlation of LCBI with recipient age, gender, hypertension, dyslipidemia, tobacco use, diabetes mellitus, white cell count, LDL, HDL, or cylex level. After dividing LCBI into categories, there was also no correlation to any of these factors. Conclusions: The majority of early post-HT patients had lipid burden by NIRS. NIRS appears to be more sensitive than angiography and IVUS in detecting lipid plaque in post-HT patients. The implications of early lipid burden remain unclear post-HT. Longitudinal follow-up is needed to determine if lipid plaque predisposes to development of TCAD. 566 Insulin Growth Factor 1 and Cardiac Allograft Vasculopathy R. Alharethi, S. Knight, O. Galenko, J. Carlquist, B. Horne, D. Budge, S. Frampton, K. Rassmusson, J. Nixon, J. Rollo, K. Brunisholz, A.G. Kfoury. UTAH Cardiac Transplant Program, Intermountain Heart Institute, Salt Lake City, UT. Purpose: Cardiac Allograft Vasculopathy (CAV) is major comorbidity after heart transplantation (OHT) with no definitive therapy besides re-transplantation. Its pathophysiology is not well defined and noninvasive markers of early disease are lacking. Low Insulin Growth Factor 1 (IGF1) and high Insulin Growth Factor Binding protein 3(IGFBP3) have been implicated in the development of atherosclerosis and native coronary artery disease (CAD). The purpose of this study is to evaluate the role of IGF1 and IGFBP3 in CAV. Methods and Materials: The Intermountain Heart Collaborative Study Registry was queried for stored blood samples for heart transplant recipients (1995-2010). IGF1 and IGFBP3 plasma levels were done by ELISA and measured at baseline before the diagnosis of CAV in the CAV group and at similar time points after transplantation in the control group (⫾2 years) which was matched by gender and age. Demographic, clinical and laboratory data were collected at the time of the sample collections. CAV was defined CAV1-3 per International Society for Heart and Lung Transplantation. A non-parametric
CAV(n¼41) DM % HTN % Average IGF1 (ng/ml)⫾std Average IGFBP3 (ng/ml))⫾std
Control (n¼41) P value
7.8 (9.8 48.8 36.6 116.66 ⫾55.73 105⫾39.02
0.69 0.37 0.61
1670.14 ⫾513.28
0.82
1623.75 ⫾1026.93
DM: Diabetes Mellitus, HTN: Hypertension, std: standard deviation Conclusions: Although low serum IGF1 is a risk factor of development of CAD, this association was not found in patients with CAV posttransplant. This observation likely reflects differences in pathophysiology between the two diseases as immunologic process plays a major role in the CAV compare to native atherosclerosis. Larger studies are needed to further explore the role of IGF1 in CAV. 567 Comparison of Optical Coherence Tomography (OCT) and Intravascular Ultrasound (IVUS) for the Early Diagnosis of Cardiac Allograft Vasculopathy in Heart Transplant Patients C.-M. Tissot,1 S. Guendouz,1 G. Mouillet,2 T. Damy,1 J.P. Couetil,3 E. Teiger,2 B. Gellen.1 1Cardiology, Henri Mondor Hospital, Creteil, France; 2Explorations Fonctionnelles, Henri Mondor Hospital, Creteil, France; 3Cardiac Surgery, Henri Mondor Hospital, Creteil, France. Purpose: Cardiac Allograft Vasculopathy (CAV) is one of the leading causes of death after cardiac transplantation. IntraVascular Ultrasound (IVUS) measures the increase in intima-media thickness (IMT) observed in CAV and is more sensitive for diagnosis of CAV than coronary angiography. Optical Coherence Tomography (OCT), a new intracoronary imaging technique, allows more precise measurement of IMT as compared to IVUS. Objective: Demonstrate that OCT is better than IVUS for CAV detection in heart transplant patients. Methods and Materials: Comparison of OCT and IVUS in heart transplant patients with or without angiographic CAV, performed during their systematic follow-up coronary angiography. Results: Among ten heart transplant patients included with a median age of 53.5þ/12 years, 4 had angiographically significant CAV. No major adverse cardiac events occurred during the procedure. Twentytwo coronary arteries, divided into 105 segments, were analysed. IMT measured by IVUS and OCT was comparable (limits of agreement [0.167 – 0.139]). The 4 patients with angiographic CAV had a thicker IMT than healthy patients as defined by IVUS (0.42 ⫾ 0.16 mm et 0.24 ⫾ 0.10 mm respectively, p o 0.001), and by OCT (0.41 ⫾ 0.16 mm and 0.27 ⫾ 0.12, p o 0.001). Only OCT allowed for separate measurement of intima and media. Intimal thickness was significantly increased in patients with CAV (0.28 ⫾ 0.15 mm vs. 0.16 ⫾ 0.09 mm, p o 0.001). Conclusions: OCT and IVUS are both reliable to measure IMT. However, only OCT can evaluate intimal thickening, the key feature of beginning CAV. OCT is therefore a promising tool in the early detection of CAV and may guide adjustment of immunosuppressive treatment aimed at reducing CAV progression. 568 Cardiac Allograft Vasculopathy Is Less Frequent in Contemporary Heart Transplant Population J. Wei, B. Azarbal, R. Cheng, D. Geft, M. Rafiei, J. Patel, L. Czer, J. Kobashigawa. Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA.