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eISSN: 1897-4295
ISSN: 1734-9338
Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej
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Sarajevo Declaration on Integrity and Visibility of Scholarly Publications
1/2025
vol. 21
 
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abstract:
Original paper

Microcirculation and intravascular imaging assessment in heart transplant recipients for detection of cardiac allograft vasculopathy: a pilot study

Michal Hawranek
1
,
Radoslaw Liszka
1
,
Agnieszka Kuczaj
2
,
Łukasz Pyka
1
,
Michał Wróbel
1
,
Mirosława Herdyńska-Wąs
2
,
Mariusz Gąsior
1
,
Piotr Przybyłowski
2

  1. Third Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Poland
  2. Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Poland
Adv Interv Cardiol 2025; 21, 1 (79): 63–66
DOI: https://doi.org/10.5114/aic.2025.147986
Online publish date: 2025/02/28
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Introduction:
Cardiac allograft vasculopathy (CAV) is the leading cause of late mortality after heart transplantation (HTx). It is a progressive and diffuse process involving both the epicardial coronary arteries and the microcirculation, caused by immunologic and non-immunologic factors resulting in localized inflammation. Microcirculatory and intravascular imaging assessments help characterize the physiological phenotype of patients and better predict their prognosis.

Aim:
To conduct a comprehensive imaging and functional evaluation of the coronary arteries for early detection of vasculopathy in patients after heart transplantation.

Material and methods:
This is a prospective, single-center study enrolling patients who underwent heart transplantation and their first coronary angiography (CA) within the first 2 years after HTx. In all patients, intravascular ultrasound was performed to detect thickening of the intima-media complex. Additionally, functional assessment of coronary arteries and microcirculation was done.

Results:
Vessels from 10 patients (mean age: 56.6 ±11.6 years) within the first two years after transplantation were assessed with additional left anterior descending (LAD) evaluation. A plaque burden of > 30% in the segment of the most significant stenosis in the LAD was observed in 70% of vessels, and thickening of the intima-media complex > 0.5 mm was observed in 60% of cases. Fractional flow reserve (FFR) < 0.8 occurred in 1 patient. The mean index of microcirculatory resistance (IMR) was 17 ±10, and mean coronary flow reserve (CFR) was 4.33 ±1.1.

Conclusions:
In heart transplantation patients, comprehensive angiographic, imaging, and physiological evaluation including microcirculation assessment may allow for early detection of allograft vasculopathy.

keywords:

heart transplantation, cardiac allograft vasculopathy, functional assessment, microcirculation
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