title: Optical coherence tomography for characterization of cardiac allograft vasculopathy in late survivors of pediatric heart transplantation.
abstract: BACKGROUND
  Optical coherence tomography (OCT) has been shown to reliably detect cardiac allograft vasculopathy (CAV). In recent studies performed in adult heart transplant (HTx) recipients, OCT revealed the presence of vulnerable plaques and complicated coronary artery lesions, thus challenging the current concept that CAV disease is a diffuse concentric and fibrosing vasculopathy. The aim of our study was to characterize CAV by OCT in a young population of HTx recipients.
  
  
  METHODS
  We prospectively enrolled 21 young HTx recipients (mean age 27 years, range 22 to 38 years) to undergo OCT of the left anterior descending coronary artery (LAD) in addition to annual CAV screening by coronary angiography and virtual histology intravascular ultrasound (VH-IVUS). Quantitative OCT analysis was performed at the site of maximal intimal thickness (MIT) for each LAD segment.
  
  
  RESULTS
  Patients were 27 years old with a mean time from cardiac transplantation of 14.7 ± 6.8 years. All patients exhibited intimal hyperplasia with an abnormal (>1) intima-to-media ratio. The median (interquartile range) MIT values by OCT were 0.37 (0.22 to 0.54) mm, 0.46 (0.29 to 0.54) mm and 0.34 (0.25 to 0.49) mm in the distal, middle and proximal LAD segments, respectively. Qualitative OCT analysis rarely showed features of vulnerable plaque or complicated lesions. Consistently, at VH-IVUS, the prevalent component at the site of MIT per vessel assessed by OCT was fibrous tissue.
  
  
  CONCLUSIONS
  Unlike recent evidence in adult HTx recipients, OCT findings of vulnerable plaque and complicated coronary lesions were found to be rare among late survivors of pediatric HTx.
authors.affiliation: Department of Cardiovascular Sciences, European Hospital, Rome. Electronic address: f.tomai@tiscali.it.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Tomai
authors.affiliation: Department of Cardiovascular Sciences, European Hospital, Rome.
authors.forename: Leonardo
authors.initials: L
authors.lastname: De Luca
authors.affiliation: Department of Cardiovascular Sciences, European Hospital, Rome.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Petrolini
authors.affiliation: CLI Foundation, Rome.
authors.forename: Luca
authors.initials: L
authors.lastname: Di Vito
authors.affiliation: Department of Cardiovascular Sciences, European Hospital, Rome.
authors.forename: Anna S
authors.initials: AS
authors.lastname: Ghini
authors.affiliation: Department of Cardiovascular Sciences, European Hospital, Rome.
authors.forename: Pierfrancesco
authors.initials: P
authors.lastname: Corvo
authors.affiliation: Department of Cardiovascular Sciences, European Hospital, Rome.
authors.forename: Giovanni
authors.initials: G
authors.lastname: De Persio
authors.affiliation: Department of Cardiology, IRCCS Ospedale Pediatrico Bambino Gesù, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Parisi
authors.affiliation: Department of Cardiology, IRCCS Ospedale Pediatrico Bambino Gesù, Rome, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Pongiglione
authors.affiliation: Department of Cardiology, IRCCS Ospedale Pediatrico Bambino Gesù, Rome, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Giulia Gagliardi
authors.affiliation: CLI Foundation, Rome.
authors.forename: Francesco
authors.initials: F
authors.lastname: Prati
mesh_terms: D000328:Adult; D064591:Allografts; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology*; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D016027:Heart Transplantation / Q000009:adverse effects* / Q000401:mortality; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology*; D011446:Prospective Studies; D015996:Survival Rate / Q000639:trends; D041623:Tomography, Optical Coherence / Q000379:methods*; D017539:Tunica Intima / Q000000981:diagnostic imaging / Q000473:pathology*; D018084:Ultrasonography, Interventional; D055815:Young Adult
keywords: cardiac allograft vasculopathy; heart transplantation; optical coherence tomography; quantitative coronary angiography; virtual histology intravascular ultrasound; young heart transplant recipients