Assessment and Characterization of Time-related Differences in Plaque Composition by Intravascular Ultrasound–derived Radiofrequency Analysis in Heart Transplant Recipients
Received 21 September 2007; received in revised form 5 December 2007; accepted 14 December 2007.
Background
The survival of heart transplant patients is limited by cardiac allograft vasculopathy (CAV). Intravascular ultrasound (IVUS) and IVUS-derived radiofrequency plaque composition analysis (IVUS-RF) provide further information about the process of coronary atherosclerosis.
Methods
In this study we aimed to assess the time-dependent differences in disease progression in patients with CAV. Fifty-six patients were divided into three groups according to time interval after transplantation (Group I: 1 to 3 months, 18 patients; Group II, 1 to 5 years, 20 patients; Group III: 5 to 15 years, 18 patients).
Results
IVUS-RF revealed time-dependent increases in all plaque components. The largest increase was shown for fibrotic, fibrofatty and necrotic tissue between Groups I and II. Dense calcium area increased uniformly in all groups. IVUS-RF–derived plaque type analysis revealed predominantly fibrotic plaques in all groups with a decrease of frequency over time. Fibrolipidic and fibrotic–calcific plaques increased uniformly. High-risk lesions, such as thick-cap fibroatheromas (FAs), increased in Groups I and II and decreased in Group III. Thin-cap FAs were detected only in Group III.
Conclusions
IVUS-RF, as compared with gray-scale IVUS, provides better detailed information about the development of CAV by plaque morphology and composition analysis in different stages after heart transplantation. Serial IVUS-RF analysis in these patients may improve the stratification of heart transplant recipients.
aDepartment of Medicine, Division of Cardiology, Medizinische Klinik und Poliklinik–Innenstadt, Munich, Germany
bDepartment of Cardiac Surgery, Klinikum Grosshadern, Ludwig-Maximilians-Universität, Munich, Germany
cDepartment of Public Health, Medical Decision Making and Health Technology Assessment, University of Health Sciences, Medical Informatics and Technology, Hall, Austria
dInstitute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Reprint requests: Andreas König, MD, Department of Medicine, Division of Cardiology, Medizinische Klinik und Poliklinik-Innenstadt, Ludwig-Maximilians-Universität, Ziemssenstrasse 1, 80336 Munich, Germany. Telephone: 0049-89-5160-7670. Fax: 0049-89-5160-2152.
ABSTRACT