Abstract 11590: Different Cardiac Allograft Vasculopathy Progression is Observed Among Three Vessels After Heart Transplantation

Introduction: Cardiac allograft vasculopathy (CAV) after heart transplantation (HTx) has been considered to diffuse similarly among the coronaries (CAs). However, individual plaque formation more than 5 years after HTx is unclear. Optical coherence tomography (OCT) provides higher resolution and ability of tissue characterization than angiography. Hypothesis: CAV progression may differ in the early and late periods after HTx. Methods: We studied 97 consecutive CAs from 39 patients (32 male, 41±14 yrs.) who received multivessel study using OCT at annual catheterization (f/u). Data were divided into 2 groups according to the period from HTx to f/u, and compared the spatial differences among CAs (early; 1-4 yrs., n=56 [LAD 22, LCX 16, RCA 18] and late; 5-17 yrs., n=41 [LAD 15, LCX 13, RCA 13]). Plaque was classified as fibroatheroma (cap thickness≤70μm=TCFA), lipid (arc>180°=large) and calcium. Macrophage, TCFA, large lipid and thrombi were considered as vulnerable. For longitudinal plaque progression we used length of IEM undamaged by plaque, expressed by % per investigated length (intact media length index). Results: Media was most intact in LCX in both groups. However, all intact media decreased similarly (figure A). Maximum intimal thickness was smallest in LCX in both early (0.9±0.4 for LAD, 0.6±0.3 for LCX, 0.9±0.4mm for RCA; P=0.06) and late (1.1±0.3, 0.6±0.2, 0.8±0.3mm; respectively: P=0.01). Spatial plaque formations among the CAs in individual patients were similar in early; however, each vessel formed plaque independently in late. Throughout the analysis, LCX presented small atherosclerotic change while vulnerable burden was detected in major CAs, such as LAD and RCA, in late (figure B). Conclusions: After 5 yrs. from HTx, CAV progresses differently among the coronary tree with individual plaque formation and maturing, ie, vulnerable change. ![][1] [1]: /embed/graphic-1.gif