Diagnosis of cardiac allograft vasculopathy using optical coherence tomography

Objective: to determine the prevalence of cardiac allograft vasculopathy (CAV), detected by optical coherence tomography (OCT), in patients after orthotopic heart transplantation (OHT), and to analyze its impact on clinical outcomes. Materials and methods. The single-center retrospective cohort study analyzed data from patients who underwent OHT between 2013 and 2024. Patients who died within 30 days after transplantation were excluded from the analysis. All recipients underwent coronary angiography during the first week after transplantation to detect baseline coronary lesions in the donor heart. Subsequently, routine angiographic screening was performed. When lesion progression or development of de novo stenoses was suspected, additional evaluation using OCT was carried out to assess lesion morphology. Based on OCT results, recipients were divided into two groups: patients with and without CAV. The study endpoints included myocardial infarction, myocardial revascularization, cardiac death, and a decrease in left ventricular ejection fraction (LVEF) during follow-up. Results. The study included 66 patients. Coronary artery disease was detected in 15 patients (22.72%) during angiographic screening. However, subsequent assessment using OCT confirmed CAV in only 10 recipients (15.15%). In all confirmed cases, the left anterior descending (LAD) artery was involved. Among patients with pre-existing coronary lesions, the median time to the first angiographic detection was 3.5 months, compared with 25 months in recipients without baseline lesions. In the CAV group, myocardial infarction occurred in 4 patients (40.0%), whereas no ischemic events were observed in the non-CAV group (p < 0.001). Myocardial revascularization was required in 7 patients (70.0%) with CAV, while in the group without this condition, only one procedure was performed for an initial lesion of the LAD artery (p = 0.005). Median LVEF in the CAV group decreased from 66.0% to 57.5%, whereas no significant changes in left ventricular systolic function were observed in patients without CAV (p = 0.045). Conclusion. OCT enables reliable, early detection of CAV. In all confirmed cases, the lesions were localized around the LAD artery. CAV developed earlier in recipients with pre-existing coronary atherosclerosis. Moreover, the presence of CAV was associated with an increased risk of myocardial infarction and the need for coronary revascularization, which was accompanied by a decline in LVEF and subsequent development of heart failure.

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