Coronary plaque composition assessed by intravascular ultrasound virtual histology: Association with long‐term clinical outcomes after heart transplantation in young adult recipients. Issue 1 (16th July 2013)

• Record Type: Journal Article
• Authors: Tomai, Fabrizio; Adorisio, Rachele; De, Leonardo; Pilati, Mara; Petrolini, Alessandro; Ghini, Anna S.; Parisi, Francesco; Pongiglione, Giacomo; Gagliardi, Maria Giulia
• Is Part Of: Catheterization and cardiovascular interventions. Volume 83:Issue 1(2014:Jan. 01)
• Page Start: 70
• Page End: 77
• Publication Date: 2013-07-16
• Subjects: Heart -- Diseases -- Diagnosis -- Periodicals; Cardiac catheterization -- Periodicals; 616.1207572
• DOI: 10.1002/ccd.25054
• Languages: English
• ISSNs: 1522-1946

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="ccd25054-sec-0001" sec-type="section"> <title>Objectives</title> <p>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.</p> </sec> <sec id="ccd25054-sec-0002" sec-type="section"> <title>Background</title> <p>Rapid progression of coronary allograft vasculopathy after heart transplantation is a powerful predictor of mortality and clinical events at long‐term.</p> </sec> <sec id="ccd25054-sec-0003" sec-type="section"> <title>Methods</title> <p>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, <italic>n</italic> = 13; group B: >5 years, <italic>n</italic> = 27).</p> </sec> <sec id="ccd25054-sec-0004" sec-type="section"> <title>Results</title> <p>Group B showed an higher percentage of necrotic core and dense calcium (12 ± 2 vs. 5 ± 1%, <italic>P</italic> = 0.04; 8.2 vs. 2.1%, <italic>P</italic> = 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 (<italic>P</italic> = 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; <italic>P</italic> = 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; <italic>P</italic> = 0.007), time from HTx (HR 1.8; 95% CI 1.6–4.8; <italic>P</italic> = 0.02), and inflammatory plaque (HR 2.4; 95% CI 1.1–5.3; <italic>P</italic> = 0.03) were independent predictors of adverse clinical events.</p> </sec> <sec id="ccd25054-sec-0005" sec-type="section"> <title>Conclusions</title> <p>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.</p> </sec> </abstract>