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Chatterjee A, Shanmugasundaram M, Lee KS, Kazui T, Rajapreyar IN, Acharya D. Optical Coherence Tomography in the Assessment and Management of Cardiac Allograft Vasculopathy. Curr Cardiol Rep 2024; 26:777-782. [PMID: 38864982 DOI: 10.1007/s11886-024-02078-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/29/2024] [Indexed: 06/13/2024]
Abstract
PURPOSE OF REVIEW Cardiac Allograft vasculopathy (CAV) is a major barrier to improving outcomes after heart transplantation. Coronary angiography has very low sensitivity to detect early CAV and intravascular ultrasound (IVUS) only improves it to some extent. In this article, we detail the current evidence surrounding use of Optical Coherence tomography (OCT) in patients with CAV. RECENT FINDINGS OCT has the ability to recognize CAV at earlier stages with intimal thickness < 150 μm, can characterize CAV in almost pathologic / microscopic detail - plaque characteristics are better visualized and novel early features such as layered fibrotic plaques and microchannels have been identified. Progression of CAV can be monitored also, with promise shown in automated serial measurements also. OCT has significantly advanced our understanding of the pathophysiology-as well as permits precise monitoring and surveillance of the disease. Potential treatment options could also be evaluated using OCT.
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Affiliation(s)
- Arka Chatterjee
- Division of Cardiology, University of Arizona College of Medicine, 1501 N Campbell Avenue, Tucson, AZ, 85719, USA.
| | - Madhan Shanmugasundaram
- Division of Cardiology, University of Arizona College of Medicine, 1501 N Campbell Avenue, Tucson, AZ, 85719, USA
| | - Kwan S Lee
- Division of Cardiology, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Toshinobu Kazui
- Department of Cardiothoracic Surgery, University of Arizona College of Medicine, Tucson, AZ, USA
| | | | - Deepak Acharya
- Division of Cardiology, University of Arizona College of Medicine, 1501 N Campbell Avenue, Tucson, AZ, 85719, USA
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Jiang X, Zhou YX, Zhou Q, Cao S. The 2-year postoperative left heart function in marginal donor heart recipients assessing by speckle tracking echocardiography. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2023; 39:1449-1459. [PMID: 37184761 DOI: 10.1007/s10554-023-02867-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 05/03/2023] [Indexed: 05/16/2023]
Abstract
This study analyzed the differences and explored the donor/recipient factors between marginal and standard donor heart recipients after heart transplantation (HT) by speckle tracking echocardiography (STE). Seventy-two HT patients were enrolled: 25 standard and 47 marginal donor heart recipients. Thirty HT patients completed 2-year continuous follow-up (1, 6, 12, 24 months). Thirty healthy volunteers were controls. STE was used to track the strain characteristics of the left ventricle and atrium for detecting early changes in marginal donor heart recipients, including left ventricular global longitudinal, circumferential and radial strain (LVGLS, LVGCS, LVGRS) and left atrial strain in systole (LAS-S) and late diastole (LAS-A). The perioperative parameters were similar between the standard and marginal groups. No significant differences were found in left heart size, systolic and diastolic function parameters. Left ventricular systolic strain (LVGLS, LVGCS, LVGRS) and systolic and late diastolic left atrial strain (LAS-S, LAS-A) were lower in the HT recipients than the control group (P < 0.05), but there was no difference between the marginal and standard groups (P > 0.05). LVGLS, LVGCS, and LAS-S were low in the marginal group 1 month after surgery but recovered gradually at 6 months. The patients with donor/recipient body weight ratio < 0.8 group had lower LVGLS and LAS-S. STE showed no significant difference between marginal and standard donor recipients. The LVGLS and LAS-S were lower in those with a smaller donor/recipient body weight ratio. The cardiac function of HT patients was lower in the early postoperative period but gradually recovered over time.
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Affiliation(s)
- Xin Jiang
- Department of Ultrasonography, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuhan, 430060, Hubei Province, China
| | - Yan-Xiang Zhou
- Department of Ultrasonography, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuhan, 430060, Hubei Province, China
| | - Qing Zhou
- Department of Ultrasonography, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuhan, 430060, Hubei Province, China.
| | - Sheng Cao
- Department of Ultrasonography, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuhan, 430060, Hubei Province, China.
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McDonald MM, Mihalj M, Zhao B, Nathan S, Matejin S, Ottaviani G, Jezovnik MK, Radovancevic R, Kar B, Gregoric ID, Buja LM. Clinicopathological correlations in heart transplantation recipients complicated by death or re-transplantation. Front Cardiovasc Med 2022; 9:1014796. [PMID: 36407445 PMCID: PMC9669710 DOI: 10.3389/fcvm.2022.1014796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 10/13/2022] [Indexed: 11/06/2022] Open
Abstract
Purpose This study aimed to identify and correlate pathological findings with clinical outcomes in patients after orthotopic heart transplantation (OHT) who either died or underwent a re-transplantation. Methodology and study design Single-center retrospective analysis of primary OHT patients who died or were re-transplanted between October 2012 and July 2021. Clinical data were matched with corresponding pathological findings from endomyocardial biopsies on antibody-mediated rejection, cellular rejection, and cardiac allograft vasculopathy. Re-assessment of available tissue samples was performed to investigate acute myocardial injury (AMI) as a distinct phenomenon. These were correlated with clinical outcomes, which included severe primary graft dysfunction. Patients were grouped according to the presence of AMI and compared. Results We identified 47 patients with truncated outcomes after the first OHT. The median age was 59 years, 36 patients (76%) were male, 25 patients (53%) had a prior history of cardiac operation, and 21 patients (45%) were supported with a durable assist device before OHT. Of those, AMI was identified in 22 (47%) patients (AMI group), and 25 patients had no AMI (non-AMI group). Groups were comparable in baseline and perioperative data. Histopathological observations in AMI group included a non-significant higher incidence of antibody-mediated rejection Grade 1 or higher (pAMR ≥ 1) (32% vs. 12%, P = 0.154), and non-significant lower incidence of severe acute cellular rejection (ACR ≥ 2R) (32% vs. 40%, P = 0.762). Clinical observations in the AMI group found a significantly higher occurrence of severe primary graft dysfunction (68% vs. 20%, P = 0.001) and a highly significant shorter duration from transplantation to death or re-transplantation (42 days [IQR 26, 120] vs. 1,133 days [711–1,664], P < 0.0001). Those patients had a significantly higher occurrence of cardiac-related deaths (64% vs. 24%, P = 0.020). No difference was observed in other outcomes. Conclusion In heart transplant recipients with a truncated postoperative course leading to either death or re-transplantation, AMI in endomyocardial biopsies was a common pathological phenomenon, which correlated with the clinical occurrence of severe primary graft dysfunction. Those patients had significantly shorter survival times and higher cardiac-related deaths. The presence of AMI suggests a truncated course after OHT.
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Affiliation(s)
- Michelle M. McDonald
- Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Maks Mihalj
- Department of Advanced Cardiopulmonary Therapies and Transplantation, University of Texas Health Science Center at Houston, Houston, TX, United States
- Department of Cardiac Surgery, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Bihong Zhao
- Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Sriram Nathan
- Department of Advanced Cardiopulmonary Therapies and Transplantation, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Stanislava Matejin
- Department of Advanced Cardiopulmonary Therapies and Transplantation, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Giulia Ottaviani
- Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at Houston, Houston, TX, United States
- Cardiovascular Pathology, Lino Rossi Research Center, Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milan, Italy
| | - Mateja K. Jezovnik
- Department of Advanced Cardiopulmonary Therapies and Transplantation, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Rajko Radovancevic
- Department of Advanced Cardiopulmonary Therapies and Transplantation, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Biswajit Kar
- Department of Advanced Cardiopulmonary Therapies and Transplantation, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Igor D. Gregoric
- Department of Advanced Cardiopulmonary Therapies and Transplantation, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - L. Maximilian Buja
- Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at Houston, Houston, TX, United States
- *Correspondence: L. Maximilian Buja,
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