Optical Coherence Tomography (OCT)—The Diagnostic Tool for Early Detection of Cardiac Allograft Vasculopathy after Pediatric Heart Transplantation

Background: Heart transplantation (HTx) is an established therapy for children with end-stage heart failure. Cardiac allograft vasculopathy (CAV) is one major limitation of graft survival in the long-term after HTx. One standard method screening for CAV is coronary angiography, but underestimation of CAV is a real concern. Therefore, intravascular imaging methods as optical coherence tomography (OCT) gives a great potential for early detection of CAV.

Methods: We reviewed retrospectively the medical history and evaluated the examination findings of patients who underwent heart transplantation in childhood or adolescence. All patients received coronary angiography and OCT during the same examination in our institution between October 2020 and June 2023. The aim was to detect risk factors for early development of CAV.

Results: 39 patients [age median 14,5 years (range, 5–33,2 years) male:female 20:19, age at HTx median 8,5 years (0,1–17,2 years), time since HTx median 6,2 years (0,4–23,5 years)], were included. 52 examinations were performed [Single examination (n = 27), two examinations (n = 11) and one patient with three examinations], 81 coronary vessels were imaged with OCT and incl. coronary angiography of all vessels. OCT was pathological (IMT >0.25mm) in 76 analyzed vessels [93.83%, median intimate thickness 0,41mm (range 0,18–1,1mm)]. Coronary angiography was evaluated according to the ISHLT CAV grading report and was considered pathologic in 12 (23,08%) examinations [2x grade 1, 5x grade 2, 1x grade 3]. Only one examination showed no pathological coronary angiography and OCT as non-pathological (2,5%), in all others at least one of the examined vessels was classified as regional pathological. The following immunosuppressants were used: EVE in 25 pts. (48%), TAC in 39 pts. (75%), CYA in 5 pts. (10%), MMF in 24 pts. (46%), AZA in 5 pts. (10%) and prednisolon in 10 pts. (19%). When CAV has been diagnosed, immunosuppressive medication has been switched to a combination with inclusion of everolimus and statin therapy.

Conclusion: OCT is a safe and valuable diagnostic tool for early detection of CAV in patients after pediatric HTx. It allows the detection of regional intimal thickening at stages where coronary angiography is still unremarkable. Whether earlier adjustment of immunosuppression has an impact on the course of CAV or graft survival needs further multicenter investigation with serial measurements on a multicenter approach in pediatric heart centers using OCT.

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Artikel online veröffentlicht:
13. Februar 2024