title: Repeated episodes of thrombosis as a potential mechanism of plaque progression in cardiac allograft vasculopathy.
abstract: OBJECTIVE
  The pathogenesis of cardiac allograft vasculopathy (CAV) remains complex and may involve multiple mechanisms. We tested the hypothesis that the multilayer (ML) appearance, an intravascular ultrasound (IVUS) finding suggestive of repetitive thrombosis, is associated with plaque progression in heart transplant (HTx) recipients.
  
  
  RESULTS
  Our study population consisted of 132 HTx recipients undergoing at least two grayscale and virtual histology (VH)-IVUS examinations. A retrospective serial analysis was performed between the first (baseline) and the last (follow-up) IVUS data during a median follow-up of 3.0 years. The subjects were divided into two groups based on the presence of the ML appearance on the baseline IVUS. At baseline, subjects with ML appearance (n = 38) had a longer time elapsed since transplant, larger vessel volume, and larger plaque volume than those without (n = 94) (all P < 0.01). Intraluminal thrombi and plaque ruptures were identified only in subjects with ML appearance (P < 0.01 vs. those without). More subjects with ML appearance at baseline developed subsequent ML formation compared with those without [21 (55%) vs. 22 (23%), P < 0.01] during follow-up. There was an increase in plaque volume, necrotic core volume, and dense calcium volume in subjects with ML appearance (all P < 0.01 vs. those without). Multivariable linear regression analysis showed that ML appearance was a potential predictor of plaque progression (regression coefficient 0.28, 95% CI 0.10-0.45, P < 0.01).
  
  
  CONCLUSIONS
  The current study demonstrates that a finding of ML appearance, indicative of repeated episodes of mural thrombosis, is not infrequent in asymptomatic HTx recipients and possibly contributes to progression of CAV.
authors.affiliation: From the Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Matsuo
authors.forename: Andrew
authors.initials: A
authors.lastname: Cassar
authors.forename: Jing
authors.initials: J
authors.lastname: Li
authors.forename: Andreas J
authors.initials: AJ
authors.lastname: Flammer
authors.forename: Byoung-Joo
authors.initials: BJ
authors.lastname: Choi
authors.forename: Joerg
authors.initials: J
authors.lastname: Herrmann
authors.forename: Rajiv
authors.initials: R
authors.lastname: Gulati
authors.forename: Ryan J
authors.initials: RJ
authors.lastname: Lennon
authors.forename: Soo-Jin
authors.initials: SJ
authors.lastname: Kang
authors.forename: Akiko
authors.initials: A
authors.lastname: Maehara
authors.forename: Hironori
authors.initials: H
authors.lastname: Kitabata
authors.forename: Takashi
authors.initials: T
authors.lastname: Akasaka
authors.forename: Lilach O
authors.initials: LO
authors.lastname: Lerman
authors.forename: Sudhir S
authors.initials: SS
authors.lastname: Kushwaha
authors.forename: Amir
authors.initials: A
authors.lastname: Lerman
mesh_terms: D064591:Allografts; D018450:Disease Progression; D005260:Female; D006083:Graft Occlusion, Vascular / Q000209:etiology* / Q000473:pathology; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D058226:Plaque, Atherosclerotic / Q000209:etiology* / Q000473:pathology; D012008:Recurrence; D012189:Retrospective Studies; D013927:Thrombosis / Q000209:etiology* / Q000473:pathology; D018084:Ultrasonography, Interventional
keywords: Cardiac allograft vasculopathy; Intravascular ultrasound; Plaque progression; Thrombosis