Intravascular ultrasound for cardiac allograft vasculopathy detection

Cardiac allograft vasculopathy (CAV) after heart transplantation is a fibro-proliferative process affecting coronary arteries of the graft in up to 46.8% of the cases during the first 10 years post-transplantation. It is one of the main causes of graft loss and death. Due to graft denervation, CAV causing ischemia is usually clinically silent until the disease is far advanced. In this study, we compared coronary angiography with intravascular ultrasound (IVUS) for CAV detection. Outcomes A total of 114 patients with HTx who underwent coronary angiography and IVUS between March 2018 and March 2019 were included. Mean follow-up was 87 +/- 61 month. Lesions documented by coronary angiography were found in only 27 (24%) of the 114 patients. IVUS revealed ISHLT CAV (0) in 87 patients (76.3%); ISHLT CAV(1) in 15 (13,1%) and ISHLT CAV(2) and CAV(3) in 6 patients (5.2%) each. Among 328 IVUS images, maximum intimal thickness (MIT) >0.5 mm was obtained in 60 vessels (52%) with 24 patients having three-vessel and 19 two-vessel involvement. Conclusion As an adjunct to conventional coronary angiography to detect angiographically silent CAV in heart transplant patients, IVUS is a reliable and safe technique with a low complication rate. Large multicenter studies are necessary to confirm these findings and the potential long-term clinical impact of early detection in clinically and angiographically silent phase.

Automated summary

Cardiac allograft vasculopathy (CAV) is a fibro-proliferative disease affecting coronary arteries post-heart transplantation. Despite often being clinically silent, IVUS is a reliable and safe technique for detecting angiographically silent CAV in heart transplant patients, with potential long-term clinical impact. Further large multicenter studies are needed to validate these findings.