title: Prevalence of cardiac allograft vasculopathy assessed with coronary angiography versus coronary vascular ultrasound and virtual histology.
abstract: BACKGROUND
  Cardiac allograft vasculopathy (CAV) is a major factor limiting long-term survival after heart transplantation (HT). The purpose of this study was to characterize the coronary artery structure and to determine the prevalence of vasculopathy after HT, comparing the sensitivity of coronary angiography with that of intravascular ultrasound (IVUS) and virtual histology (VH).
  
  
  METHODS
  A prospective recruitment cross-sectional study was performed in 31 adult HT recipients including 22 men and, 9 women of overall mean age of 45.2 ± 12.6 years at an average of 3.7 ± 3.7 years after transplantation. They underwent simultaneously coronary angiography and IVUS assessment of the left anterior descending coronary artery. We investigated histological composition of the intima. Final data were analyzed using parametric and nonparametric tests.
  
  
  RESULTS
  IVUS discovered the presence of CAV among 17/31 (54.8%) patients versus coronary angiography in 10 (32.3%; P = .009). The histological composition of the intima as assessed with IVUS VH was 26.1% fiber, 8.7% necrotic core, 5.7% calcium, and 4.3% lipid. There was no significant association between preexistent risk factors and the presence of CAV. There was a correlation between time elapsed since HT and CAV development.
  
  
  CONCLUSIONS
  Time elapsed since HT is the most important risk factor for the development of CAV. Its prevalence almost doubled when measured with IVUS in contrast with angiography. IVUS was thus shown to be a more sensitive diagnostic tool compared with coronary angiography.
authors.affiliation: Gustavo Fricke Hospital, Viña del Mar, Chile. torresh@gmail.com
authors.forename: H J
authors.initials: HJ
authors.lastname: Torres
authors.forename: L
authors.initials: L
authors.lastname: Merello
authors.forename: S A
authors.initials: SA
authors.lastname: Ramos
authors.forename: M A
authors.initials: MA
authors.lastname: Aninat
authors.forename: L E
authors.initials: LE
authors.lastname: Becerra
authors.forename: A D
authors.initials: AD
authors.lastname: Mora
authors.forename: P T
authors.initials: PT
authors.lastname: Valenzuela
authors.forename: M J
authors.initials: MJ
authors.lastname: Godoy
authors.forename: A A
authors.initials: AA
authors.lastname: Prieto
mesh_terms: D000328:Adult; D002677:Chile; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000473:pathology; D003430:Cross-Sectional Studies; D005260:Female; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015995:Prevalence; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional