The value of routine intracoronary ultrasound to assess coronary artery disease in cardiac allograft recipients.
Cardiac allograft vasculopathy is the main cause of morbidity and mortality after cardiac transplantation. Intravascular ultrasound (IVUS) is a sensitive imaging technique that provides detailed quantification of coronary atherosclerosis burden and could be a complement to routine angiography.


OBJECTIVE
To determine the value of IVUS for detecting silent atherosclerotic disease in cardiac allograft recipients.


METHODS
The study cohort consisted of 40 consecutive patients (mean age 55 +/- 11 years, 25% female) who underwent left anterior descending coronary artery IVUS (Volcano Therapeutics, Inc.) examination after transplantation. None of the patients had suspected or documented ischemia. Cardiac transplantation was due to ischemic cardiomyopathy in 30% (12 patients). Coronary artery disease (CAD) was defined as the presence of > or = 30% stenosis of vessel diameter (QCA analysis - Siemens CASS) on angiography and atherosclerotic lesions causing > or = 30% stenosis of vessel area by IVUS. The angiographic definition of significant CAD lesions was > or = 50% stenosis of vessel diameter, and by IVUS a minimum cross-sectional area of < or = 4 mm2.


RESULTS
CAD was identified in 20% (8 patients) by angiography and in 55% (22 patients) by IVUS (p = 0.003). Significant CAD was detected in 15% (6 patients) by angiography and in 7.5% (3 patients) by IVUS (p = 0.3).


CONCLUSIONS
The use of IVUS on routine screening coronary angiography detects a higher prevalence of early atherosclerotic disease than normal angiography, which should lead to implementation of preventive strategies to control disease progression. IVUS was no more sensitive than angiography in detecting severe coronary stenosis. IVUS should be used as a standard imaging technique together with routine coronary angiography to assess atherosclerosis burden in cardiac allograft recipients.
Calé
Rita
R
Departamento de Cardiologia e Cirurgia Cárdio-Torácica, Hospital Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide, Portugal. ritacale@spc.pt
Almeida
Manuel
M
Rebocho
Maria José
MJ
Aguiar
Carlos
C
Sousa
Pedro
P
Brito
João
J
Varandas
Eduardo
E
Figueiredo
Henrique
H
Gonçalves
Pedro
P
Raposo
Luís
L
Teles
Rui
R
Machado
Francisco
F
Queirós e Melo
João
J
Silva
José Aniceto
JA
D000328:Adult; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D005260:Female; D016027:Heart Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging*; D018084:Ultrasonography, Interventional