Coronary plaque composition assessed by intravascular ultrasound virtual histology: Association with long-term clinical outcomes after heart transplantation in young adult recipients

Fabrizio Tomai, Rachele Adorisio, Leonardo De Luca, Mara Pilati, Alessandro Petrolini, Anna S. Ghini, Francesco Parisi, Giacomo Pongiglione, Maria Giulia Gagliardi

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives To assess coronary plaque composition by virtual histology intravascular ultrasound (VH-IVUS) analysis in young adult recipients and to correlate these findings with time from heart transplant (HTx) and long-term outcomes. Background Rapid progression of coronary allograft vasculopathy after heart transplantation is a powerful predictor of mortality and clinical events at long-term. Methods Forty consecutive young adult recipients transplanted during childhood undergoing VH-IVUS during coronary surveillance have been prospectively included in this study. According to the time interval from HTx to VH-IVUS assessment, our cohort was divided into two groups (group A: ≤5 years, n = 13; group B: >5 years, n = 27). Results Group B showed an higher percentage of necrotic core and dense calcium (12 ± 2 vs. 5 ± 1%, P = 0.04; 8.2 vs. 2.1%, P = 0.03; respectively). An "inflammatory plaque" (necrotic core and dense calcium ≥30%) was detected in 34.8% of patients in group B and in none among group A patients (P = 0.03). Patients in group B had a number of adverse clinical events significantly higher than group A patients (53.8 vs. 14.3%; HR 4.45; 95% CI 1.62-12.16; P = 0.029) at long-term follow-up (4.2 years). The multivariate regression analysis showed that age (HR 1.5; 95% CI 1.1-2.0; P = 0.007), time from HTx (HR 1.8; 95% CI 1.6-4.8; P = 0.02), and inflammatory plaque (HR 2.4; 95% CI 1.1-5.3; P = 0.03) were independent predictors of adverse clinical events. Conclusions This study supports the hypothesis that time-dependent differences in plaque composition, as assessed by VH-IVUS, occur after HTx in young adult recipients, probably determining an increased risk of long-term clinical events. © 2013 Wiley Periodicals, Inc.

Original languageEnglish
Pages (from-to)70-77
Number of pages8
JournalCatheterization and Cardiovascular Interventions
Volume83
Issue number1
DOIs
Publication statusPublished - Jan 1 2014

Keywords

  • coronary allograft vasculopathy
  • heart transplantation
  • virtual histology intravascular ultrasound
  • young adult recipients

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

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