Intravascular ultrasound imaging after cardiac transplantation: Advantage of multi-vessel imaging

Background: Intravascular ultrasound is a sensitive tool to study transplan t vasculopathy. However, there is no consensus regarding the methodology fo r imaging protocol. The impact of single versus multiple epicardial vessel imaging in determining the prevalence of transplant vasculopathy has not be en determined. This study examines the benefit of three-vessel imaging vers us one-vessel imaging in detecting transplant vasculopathy. Methods and Results: One hundred eleven transplant recipients with intravas cular ultrasound imaging at baseline (within 2 months of transplantation) w ere studied: 107 at 1-year, 53 at 2-year and 41 at 3-year follow-up. A tota l of 222 arteries, 519 segments and 772 sites were analyzed (94 LAD, 65 LCX and 65 RCA). The prevalence of transplant vasculopathy lesions was 27%, 41 % and 58% at 1 year, 39%, 55% and 71% at 2 years and 39%, 55% and 74% at 3 years for patients with one-, two- and three-vessel imaging, respectively. Single- or two-vessel, disease was present in 23% (7) and 32% (10) patients with three-vessel imaging, leading to the potential mislabeling of these 1 7 (55%) patients as "disease free" if they underwent only single-vessel ima ging. Conclusions: Multivessel imaging is more sensitive in detecting the transpl ant vasculopathy lesions compared to single-vessel, imaging. This important variable should be considered when designing and interpreting trials utili zing intravascular imaging derived end-point.