Author + information
- Received January 23, 2018
- Revision received April 22, 2018
- Accepted April 26, 2018
- Published online January 16, 2019.
- Eimear McGovern, MBa,
- Martin C.K. Hosking, MDa,
- Enrique Balbacid, MD, PhDb,
- Christine Voss, PhDa,
- Felix Berger, MD, PhDc,
- Stephan Schubert, MDc,∗ and
- Kevin C. Harris, MD, MHSca,∗∗ ()
- aDivision of Cardiology, Department of Pediatrics, British Columbia Children’s Hospital, Vancouver, British Columbia, Canada
- bPediatric Cardiology Department, La Paz Children’s University Hospital, Madrid, Spain
- cDepartment of Pediatric Cardiology and Congenital Heart Disease, Deutsches Herzzentrum Berlin, Berlin, Germany
- ↵∗Address for correspondence:
Dr. Kevin C. Harris, Children’s Heart Center, British Columbia Children’s Hospital, 1F3-4480 Oak Street, Vancouver, British Columbia V6H 3V4, Canada.
Objectives This study sought to describe the initial findings from the International Pediatric Optical Coherence Tomography (OCT) registry in pediatric heart transplant recipients.
Background Cardiac allograft vasculopathy (CAV) is a common cause of late graft failure and mortality in pediatric heart transplant recipients. Early diagnosis may improve outcomes. OCT is a high-resolution intravascular imaging technique that has the potential to identify CAV earlier than angiography.
Methods OCT and angiography of the coronary arteries were performed in pediatric heart transplant recipients at participating centers. Demographics, clinical data, medications, episodes of rejection, and angiographically confirmed CAV were collected for each case. OCT and angiography images were analyzed in a central core imaging laboratory. Intimal thickness and intima/media cross sectional area (I/M CSA) ratios were calculated for each case. Intimal thickness ≥0.25 mm was defined as abnormal and ≥0.4 mm as severe intima thickening. I/M CSA ratio of ≥1 was defined as abnormal. OCT findings were compared to angiographic findings for each case.
Results Across 3 centers, 110 cases were analyzed from 76 patients. Intimal thickening was present in 26 of 110 cases. Eleven of these cases had severe intima thickening (≥0.4 mm) and notably, angiography results were normal in 8 cases. All 5 cases with a median I/M CSA ratio of ≥2 had normal angiography. The maximal intima thickness was ≥0.25 mm in 24% and ≥0.4 mm in 10% of cases. Median I/M CSA ratio was ≥1 for 80% of cases. I/M CSA ratio was significantly higher in cases with concurrent CAV (p = 0.03). Maximal intima thickness was significantly greater in cases with current or previous rejection (p = 0.01). I/M CSA ratio was significantly lower in patients treated with statins (p = 0.01). OCT findings alone prompted a change to medical management in 17% of cases.
Conclusions OCT provides important insights into coronary vascular changes not detected by angiography in pediatric transplant recipients. The use of OCT for pediatric heart transplant recipients should be further investigated, given its potential to impact the management of CAV.
↵∗ Drs. Schubert and Harris contributed equally to this work and are joint senior authors.
Support from the Canadian Foundation for Innovation (PI: Dr. Harris), operating funds from the Transplant Research Foundation of BC Venture Grant (PI Harris), and Rare Diseases Foundation (PI: Dr. Harris). Use of optical coherence tomography in Berlin patients was supported by Stiftung Kinderherz.
Dr. Harris has consulted for St. Jude Medical (now Abbott); and has proctored for Gore. Dr. Schubert has proctored and consulted for Medtronic and Gore; and has received research and travel grants from Novartis and Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received January 23, 2018.
- Revision received April 22, 2018.
- Accepted April 26, 2018.
- 2019 American College of Cardiology Foundation
This article requires a subscription or purchase to view the full text. If you are a subscriber or member, click Login or the Subscribe link (top menu above) to access this article.