title: Virtual histology intravascular ultrasound assessment of cardiac allograft vasculopathy from 1 to 20 years after heart transplantation.
abstract: BACKGROUND
  Cardiac allograft vasculopathy (CAV) is the main cause of graft loss and death in heart transplant (HTx) recipients surviving >1 year. There is a dual etiology for coronary disease in HTx: classic atherosclerosis and an immunologically mediated disease. Intravascular ultrasound (IVUS) is highly sensitive for CAV detection; however, gray-scale IVUS is of limited value for identification of specific plaque components. We sought to characterize graft coronary artery disease by means of IVUS-virtual histology (IVUS-VH) at different time-points of follow-up and to correlate plaque composition with clinical factors.
  
  
  METHODS
  In our study we included 67 patients, who were 7.6 +/- 5.7 years post-HTx. IVUS gray-scale evaluation was performed on all patients. IVUS-VH analysis was done in those patients showing intimal thickening >0.5 mm at the three more significant lesions (three cross-sections for each) of the left anterior descending artery.
  
  
  RESULTS
  IVUS-VH analysis was obtained done on 58 patients (86.5%). We found a significant correlation between time of HTx and IVUS gray-scale parameters (plaque area and plaque burden), with both increasing over time. We also found a significant correlation between time and IVUS-VH-derived plaque components, necrotic core and calcium, which increased with time, and fibrous and fibrofatty components, both decreased at follow-up. IVUS-VH results were also related to donor age and cardiovascular risk factors.
  
  
  CONCLUSIONS
  We observed a time-related change in IVUS-VH-derived plaque composition. Necrotic core and calcium, typical atheromatous components, become more prevalent with time after HTx, especially when influenced by cardiovascular risk factors. The presence of a necrotic core in the early stages was linked to older donor age.
authors.affiliation: Interventional Cardiology Department, Servicio de Cardiología, Hospital Universitario Marques de Valdecilla, Santander, Spain. he1thj@humv.es
authors.forename: Jose M de la Torre
authors.initials: JM
authors.lastname: Hernandez
authors.forename: Jose A Vazquez
authors.initials: JA
authors.lastname: de Prada
authors.forename: Virginia
authors.initials: V
authors.lastname: Burgos
authors.forename: Fermin
authors.initials: F
authors.lastname: Sainz Laso
authors.forename: Monica Fernandez
authors.initials: MF
authors.lastname: Valls
authors.forename: Francisco Gonzalez
authors.initials: FG
authors.lastname: Vilchez
authors.forename: Miguel
authors.initials: M
authors.lastname: Llano
authors.forename: Javier
authors.initials: J
authors.lastname: Ruano
authors.forename: Javier
authors.initials: J
authors.lastname: Zueco
authors.forename: Thierry
authors.initials: T
authors.lastname: Colman
authors.forename: Rafael Martín
authors.initials: RM
authors.lastname: Duran
mesh_terms: D000368:Aged; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000473:pathology; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging* / Q000473:pathology; D017023:Coronary Angiography; D004452:Echocardiography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000145:classification / Q000150:complications / Q000601:surgery; D016027:Heart Transplantation / Q000009:adverse effects / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D013997:Time Factors; D014019:Tissue Donors / Q000706:statistics & numerical data; D014584:User-Computer Interface