Heart failure & cardiomyopathies
Fibrotic Plaque and Microvascular Dysfunction Predict Early Cardiac Allograft Vasculopathy Progression After Heart Transplantation: The Early Post Transplant Cardiac Allograft Vasculopathy Study
Authors' conclusion
Fibrotic plaque on optical coherence tomography and index of microcirculatory resistance early posttransplant predict CAV progression in the first year of transplantation.
Study context
- Population
- Heart transplant recipients evaluated 3 and 12 months posttransplant with angiography and LAD IVUS, OCT, FFR, CFR and IMRcompleted evaluation
- Participants
- 82 recipients
- Outcome
- CAV progression: IVUS change in percentage intimal volume
- Follow-up
- baseline to 12-month follow-up
Methodological details2 institutions, Enrolled January 2018 to March 2021
- 2 institutions
- Enrolled January 2018 to March 2021
Main finding
As reported in the abstract
Predictors of coronary disease progression (multivariable linear regression)
- Recipient male sex, fibrotic plaque and index of microcirculatory resistance were independent predictors of coronary disease progression
Observational data: associations, not effects.
Further findings
Donor atherosclerosis (baseline IVUS maximal intimal thickness ≥0.5 mm)
- Prevalence
- 50%
De novo cardiac allograft vasculopathy (CAV) and rapidly progressive CAV · 12 months
- De novo CAV (follow-up maximal intimal thickness ≥0.5 mm)
- 24%
- Rapidly progressive CAV (maximal intimal thickness ≥0.5-mm increase from baseline)
- 13%
OCT changes baseline to follow-up
- Median intimal volume increase
- 42% (0.58 mm3/mm)
- Percentage intimal volume increase
- 44% (4.6%)
- Vessel volume decrease
- 4% (−0.50 mm3/mm)
- Lumen volume decrease
- 9% (−1.02 mm3/mm)
- P<0.05 for all
Fibrotic plaque (predominant morphology)
- Baseline
- 29%
- Follow-up
- 50%
Abnormal coronary physiology
- Baseline
- 41%
- Follow-up
- 45%
- Microvascular dysfunction (IMR ≥25)
- 1 in 5
Original publication
Fibrotic Plaque and Microvascular Dysfunction Predict Early Cardiac Allograft Vasculopathy Progression After Heart Transplantation: The Early Post Transplant Cardiac Allograft Vasculopathy Study. Circ Heart Fail. Published 11 May 2023. doi:10.
Summarised from the published abstract; every number is checked against it