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Intravascular ultrasound of the proximal left anterior descending artery is sufficient to detect early cardiac allograft vasculopathy
Author(s) -
Floré Vincent,
Brown Adam J.,
Pettit Stephen J.,
West Nick E. J.,
Lewis Clive,
Parameshwar Jayan,
Hoole Stephen P.
Publication year - 2018
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.13167
Subject(s) - intravascular ultrasound , medicine , circumflex , ostium , artery , right coronary artery , cardiology , radiology , angiography , coronary angiography , myocardial infarction
Objective Cardiac allograft vasculopathy ( CAV ) can be detected early with intravascular ultrasound ( IVUS ), but there is limited information on the most efficient imaging protocol. Methods Coronary angiography and IVUS of the three coronary arteries were performed. Volumetric IVUS analysis was performed, and a Stanford grade determined for each vessel. Results Eighteen patients were included 18 (range 12‐24) months after transplantation. Angiographic CAV severity ranged from none ( CAV 0) to mild ( CAV 1), whereas IVUS CAV severity ranged from none (Stanford grade I) to severe (grade IV ). Maximal intimal thickness measured with IVUS was significantly greater in the LAD (0.84 ± 0.48 mm) than in the LCX (0.46 ± 0.32 mm) or the RCA (0.53 ± 0.41 mm, P = .005). Diagnostic accuracy of IVUS in the left anterior descending artery was 100% (18 of 18 Stanford grades matched the patient's highest overall Stanford grade), 66% in the right coronary artery (12 of 18), and 56% in the left circumflex artery (11 of 18). The minimal required length of left anterior descending artery pullbacks to attain 100% accuracy was 36 mm (range 3‐36 mm) distal from the guide catheter ostium. Conclusions These data suggest that focal IVUS imaging of the proximal LAD followed by volumetric analysis may suffice when screening for transplant vasculopathy.