Cardiac Allograft Vasculopathy Can Be Distinguished From Donor-Transmitted Coronary Atherosclerosis by Optical Coherence Tomography Imaging in a Heart Transplantation Recipient Double Layered Intimal Thickness

Teruhiko Imamura; Koichiro Kinugawa; Takahide Murasawa; Yukie Kagami; Miyoko Endo; Hironori Muraoka; Takeo Fujino; Toshiro Inaba; Hisataka Maki; Masaru Hatano; Osamu Kinoshita; Kan Nawata; Shunei Kyo; Issei Komuro; Minoru Ono

doi:10.1536/ihj.13-279

Case Reports

Cardiac Allograft Vasculopathy Can Be Distinguished From Donor-Transmitted Coronary Atherosclerosis by Optical Coherence Tomography Imaging in a Heart Transplantation Recipient

Double Layered Intimal Thickness

Teruhiko Imamura, Koichiro Kinugawa, Takahide Murasawa, Yukie Kagami, Miyoko Endo, Hironori Muraoka, Takeo Fujino, Toshiro Inaba, Hisataka Maki, Masaru Hatano, Osamu Kinoshita, Kan Nawata, Shunei Kyo, Issei Komuro, Minoru Ono

Author information

Teruhiko Imamura
Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo
Koichiro Kinugawa
Department of Therapeutic Strategy for Heart Failure, Graduate School of Medicine, University of Tokyo
Takahide Murasawa
Department of Medical Engineering, Graduate School of Medicine, University of Tokyo
Yukie Kagami
Department of Organ Transplantation, Graduate School of Medicine, University of Tokyo
Miyoko Endo
Department of Organ Transplantation, Graduate School of Medicine, University of Tokyo
Hironori Muraoka
Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo
Takeo Fujino
Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo
Toshiro Inaba
Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo
Hisataka Maki
Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo
Masaru Hatano
Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo
Osamu Kinoshita
Department of Cardiothoracic Surgery, Graduate School of Medicine, University of Tokyo
Kan Nawata
Department of Cardiothoracic Surgery, Graduate School of Medicine, University of Tokyo
Shunei Kyo
Department of Therapeutic Strategy for Heart Failure, Graduate School of Medicine, University of Tokyo
Issei Komuro
Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo
Minoru Ono
Department of Cardiothoracic Surgery, Graduate School of Medicine, University of Tokyo

Keywords: Intima, Everolimus, Intravascular ultrasound

JOURNAL FREE ACCESS

2014 Volume 55 Issue 2 Pages 178-180

DOI https://doi.org/10.1536/ihj.13-279

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Abstract

Although survival after heart transplantation (HTx) has improved in recent years, cardiac allograft vasculopathy (CAV) is still the leading cause of remote morbidity and mortality in HTx recipients, partly because of difficulty with its diagnosis. In general, routine surveillance for CAV is advocated with coronary angiography accompanied by intravascular ultrasound (IVUS) if necessary. However, these modalities have limitations with respect to low spatial resolution, and sufficient qualitative/quantitative assessment of coronary intima has not been accomplished. Recently, optical coherence tomography (OCT) has emerged as a novel intracoronary imaging technique using an optical analogue of ultrasound with a spatial resolution of 10-20 µm, which is 10 times greater than IVUS. We here experienced a 49-year-old male who received a HTx 3 years ago, and OCT was executed during low molecular weight dextran injection. OCT demonstrated distinct double intimal layers probably consisting of a donor-transmitted atherosclerotic layer and an inner intimal proliferation due to CAV, which was indistinguishable by IVUS and virtual histological analyses. We believe that OCT imaging is not only a new loadstar during treatment of CAV but also a new generation modality for screening for early CAV in HTx recipients.

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