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Background  Cardiac allograft vasculopathy is the leading cause of graft failure and death in heart transplant ( HT x) recipients; however, the association between the etiology of heart failure (ischemic cardiomyopathy [ ICM ] or non‐ ICM ) that led to  HT x and progression of c ardiac allograft vasculopathy , and adverse events after  HT x has not been explored.    Methods and Results  We retrospectively included 165  HT x patients, who were followed‐up with at least 2 virtual histology–intravascular ultrasound examinations after  HT x, and grouped them as  ICM  (n=46) or non‐ ICM  (n=119). Coronary artery plaque volume was analyzed using virtual histology–intravascular ultrasound, and cardiovascular event data—a composite of myocardial infarction, hospitalization for heart failure and arrhythmia, revascularization, retransplantation, and death including cardiovascular death—were collected from the medical records of all study subjects.  ICM  patients had significantly higher plaque volume at both first ( P =0.040) and follow‐up ( P =0.015) intravascular ultrasound examinations. After multivariate adjustment for traditional coronary risk factors,  ICM  was significantly associated with plaque progression (odds ratio 3.10;  CI  1.17 to 9.36;  P =0.023). Ten‐year cardiovascular event‐free survival was 50% in  ICM  patients compared with 84% in non‐ ICM  patients (log‐rank test  P =0.003). In multivariate Cox proportional hazard analysis,  ICM  was significantly associated with a higher event rate after  HT x (hazard ratio 2.02; 95%  CI  1.01 to 4.00;  P =0.048).    Conclusion  Our study demonstrates that ischemic etiology of cardiomyopathy prior to  HT x may be independently associated with plaque progression and higher event rate after  HT x.

Ischemic Cardiomyopathy is Associated With Coronary Plaque Progression and Higher Event Rate in Patients After Cardiac Transplantation