title: The value of routine intracoronary ultrasound to assess coronary artery disease in cardiac allograft recipients.
abstract: 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.
authors.affiliation: Departamento de Cardiologia e Cirurgia Cárdio-Torácica, Hospital Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide, Portugal. ritacale@spc.pt
authors.forename: Rita
authors.initials: R
authors.lastname: Calé
authors.forename: Manuel
authors.initials: M
authors.lastname: Almeida
authors.forename: Maria José
authors.initials: MJ
authors.lastname: Rebocho
authors.forename: Carlos
authors.initials: C
authors.lastname: Aguiar
authors.forename: Pedro
authors.initials: P
authors.lastname: Sousa
authors.forename: João
authors.initials: J
authors.lastname: Brito
authors.forename: Eduardo
authors.initials: E
authors.lastname: Varandas
authors.forename: Henrique
authors.initials: H
authors.lastname: Figueiredo
authors.forename: Pedro
authors.initials: P
authors.lastname: Gonçalves
authors.forename: Luís
authors.initials: L
authors.lastname: Raposo
authors.forename: Rui
authors.initials: R
authors.lastname: Teles
authors.forename: Francisco
authors.initials: F
authors.lastname: Machado
authors.forename: João
authors.initials: J
authors.lastname: Queirós e Melo
authors.forename: José Aniceto
authors.initials: JA
authors.lastname: Silva
mesh_terms: 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