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Multicenter assessment of coronary allograft vasculopathy by intravascular ultrasound-derived analysis of plaque composition

Nature Clinical Practice Cardiovascular Medicine volume 6, pages 61–69 (2009)Cite this article

An Article Report to this article was published on 01 March 2009

Abstract

Background Coronary allograft vasculopathy is a severe complication of heart transplantation. We used virtual histology intravascular ultrasound to characterize plaque burden and tissue composition over time in heart transplant recipients.

Methods We recruited patients undergoing heart transplantation in four centers in Europe and the US between 2004 and 2006. We used intravascular ultrasound to obtain morphological plaque measurements and to perform virtual histology in the left anterior descending coronary artery. Data were characterized according to the duration between transplantation and intravascular ultrasound assessment: ≤24, >24–60, >60–120 and >120–192 months.

Results We assessed vessels from 152 patients (mean age 58 ± 12 years) a mean of 70 ± 53 months (range 1 week to 16 years) after transplantation. Plaque burden of >40% was observed in 26% of vessels analyzed, with increases from baseline being seen in all time categories. If assessed >24 months after transplantation, necrotic core and dense calcified volumes were significantly greater than at baseline (P = 0.0005 and P = 0.01, respectively). Time since heart transplantation and donor age and recipient age were independent predictive factors of increased necrotic core content. Necrotic core volume >2.01 mm3, diabetes mellitus, donor age older than 40 years, follow-up from transplantation longer than 5 years and recipient age older than 58 years were associated with the need for revascularization.

Conclusions In coronary allograft vasculopathy, plaque burden and composition change over time and seem to affect clinical outcome. This relationship might facilitate identification of high-risk patients in whom the value of more aggressive medical therapy should be tested.

Key Points

  • Time-dependent increases in the necrotic core content of plaques occur in patients with coronary allograft vasculopathy

  • Necrotic core content was increased in patients whose heart came from a donor older than 58 years

  • Patients who had plaques with large necrotic cores were at risk of needing coronary revascularization

  • Identification of clinical factors that can affect plaque volume and plaque composition could help to identify patients at increased risk of rapidly developing vasculopathy; the value of aggressive therapy for these patients should be tested

  • The beneficial effects of newer immunosuppressive or anti-inflammatory therapies that might reduce development of coronary allograft vasculopathy or stabilize plaque composition could be evaluated by sequential virtual histology ultrasonography

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Figure 1: Virtual histology intravascular ultrasound images of plaque in the left anterior descending coronary artery of a patient with coronary allograft vasculopathy.
Figure 2: Plaque burden by time since transplantation.
Figure 3: Analysis of each plaque component with time since transplantation.
Figure 4: Progression of necrotic core volume according to the age of the heart donor.

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Acknowledgements

We thank Angela Richter, Volcano Therapeutics Corporation, for her relentless collaboration with the data collection and virtual histology intravascular ultrasound analysis, as well as Armelle Guenegou, Cardio3 Biosciences, Braine-l'Alleud, Belgium, and Isabel Decramer, Cardiovascular Center, Aalst, Belgium, for their expert assistance with the statistical analysis.

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Authors and Affiliations

  1. Cardiovascular Center, OLV Hospital, Aalst, Belgium

    Giovanna Sarno, Marc Goethals, Sofie Verstreken, Jozef Bartunek, William Wijns & Marc Vanderheyden

  2. Division of Cardiovascular Diseases, Center for Coronary Physiology and Imaging, Mayo Clinic, Rochester, MN, USA

    Amir Lerman

  3. Division of Cardiology, College of Medicine, Konyang University Hospital, Daejeon, South Korea

    Jang-Ho Bae

  4. Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria

    Christoph Schukro & Dietmar Glogar

  5. Volcano Therapeutics Corporation, Rancho Cordova, CA, USA

    Pauliina M Margolis

  6. Department of Cardiology, Division of Internal Medicine, University of Munich, Munich, Germany

    Andreas Koenig

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Correspondence to Marc Vanderheyden.

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Sarno, G., Lerman, A., Bae, JH. et al. Multicenter assessment of coronary allograft vasculopathy by intravascular ultrasound-derived analysis of plaque composition. Nat Rev Cardiol 6, 61–69 (2009). https://doi.org/10.1038/ncpcardio1410

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