Fibrotic plaques in heart transplanted patients and their association with insulin resistance syndrome and Lp(a). (15th September 2022)

• Record Type: Journal Article
• Authors: Orban, Madeleine; Kuehl, Anne; Dischl, Dominic; Müller, Christoph; Ulrich, Sarah; Petzold, Tobias; Rizas, Konstantinos D.; Orban, Martin; Braun, Daniel; Hausleiter, Jörg; Hagl, Christian; Mehilli, Julinda; Massberg, Steffen
• Is Part Of: International journal of cardiology. Volume 363(2022)
• Page Start: 218
• Page End: 224
• Publication Date: 2022-09-15
• Subjects: Cardiac allograft vasculopathy -- Optical coherence tomography -- Fibrotic plaques -- Risk factors -- Prevention; CAV Cardiac allograft vasculopathy -- CAVangio Angiographic manifest CAV -- CAVIH Intimal hyperplasia in CAV -- HDL-c High-density lipoprotein -- HTx Heart transplantation -- ISHLT International Society for Heart and Lung Transplantation -- IVUS Intravascular Ultrasound -- Lp(a) Lipoprotein(a) -- LDL-c Low-density lipoprotein -- OCT Optical coherence tomography -- TG/HDL-c Triglycerides to HDL-c ratio; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2022.06.062
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: Angiographic evidence of cardiac allograft vasculopathy (CAVangio ) is a major limiting factor to survival after heart transplantation (HTx). Prevention of CAVangio is therefore most relevant. Whether modifiable risk factors could be targeted for the prevention of fibrotic plaques, that are common and related to CAVangio, is not clear. Methods and results: In a cohort of 74 consecutive HTx patients (median post-transplant interval 9.2 [4.1–15.5] years), we used the high resolution of optical coherence tomography (OCT) to quantify angulation parameters (maximal and mean arc) and plaque load (mean arc*relative plaque length) of fibrotic plaques. Mean arc was defined as the mean value of all angulation measurements per patient. We assessed the association between cardiovascular risk factors and OCT findings. Linear regression analysis showed a significant association of TG/HDL-c with mean fibrotic arc (12.7 [3.9–21.5], p = 0.006) and fibrotic plaque load (2298 [617–3979], p = 0.009) after adjustment for recipient age and sex. We used the median value of fibrotic plaque load to define high fibrotic plaque load. In binary logistic regression analysis, TG/HDL-c (odds ratio [OR] 1.81 with 95% CI [1.09–3.03], p = 0.02) and Lp(a) (OR 1.02 [1.00–1.05], p = 0.02) were associated with high fibrotic plaque load. Multivariable logistic regression analysis confirmed Lp(a) as significant predictor of high fibrotic plaque load (OR 1.03 [1.01–1.05], p = 0.02). Conclusion: TG/HDL-c ratio, a surrogate of insulin resistance syndrome, and Lp(a) were significantly associated with fibrotic plaque in HTx patients. Insulin resistance syndrome and Lp(a) might therefore represent additional targets for CAV prevention. Highlights: Cardiac allograft vasculopathy (CAV) limits survival after heart transplantation. Fibrotic plaques are common and clinically relevant in CAV. Whether modifiable risk factors are associated with fibrotic plaques is not clear. TG/HDL-c was associated with continuous measurements of fibrotic plaques in OCT. TG/HDL-c and Lp(a) were associated with high fibrotic plaque load.