We sought to explore differences in distribution and morphology of coronary lesions
comparing cardiac allograft vasculopathy and native coronary atherosclerosis (NCA)
using intravascular imaging with optical coherence tomography (OCT). At the time of
routine surveillance angiography, 17 heart transplant (HT) recipients with a history
of high-grade cellular rejection (HGR) and 43 HT recipients with none/mild (low)-grade
rejection underwent OCT imaging of the left anterior descending and were compared
to 60 patients with NCA without HT. Compared with patients with NCA, patients with
HGR had similar intima areas but smaller external elastic lamina areas (7.9 mm2 [6.3, 11.2] versus 6.6 mm2 [4.8, 7.5], p = 0.02) resulting in smaller lumen areas (4.5 mm2 [3.4, 6.6] versus 3.3 mm2 [2.8, 4.7], p = 0.04) in distal segments and smaller lumen diameters in side branches
(1.28 mm [1.19, 1.37] versus 1.09 mm [0.94, 1.24], p = 0.04). Compared with patients
with NCA, lesions in patients with HT were more homogeneous, involving the entire
coronary vascular tree. Patients with HGR had a higher prevalence of macrophages involving
≥1 quadrant in all 3 segments compared with patients with NCA. The number of microvessels
was greater in patients with both HGR and LGR HT versus NCA. In conclusion, distinct
findings in the distribution and morphology of coronary lesions between HT recipients
and patients with NCA are evident by OCT imaging, suggesting that OCT might be useful
to help differentiate cardiac allograft vasculopathy from NCA in vivo.
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Article Info
Publication History
Published online: January 28, 2016
Accepted:
January 20,
2016
Received in revised form:
January 20,
2016
Received:
October 21,
2015
Footnotes
Drs. Shan and Dong contributed equally to this manuscript.
See page 1368 for disclosure information.
Identification
Copyright
© 2016 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
