2025 Volume 89 Issue 2 Pages 255-
The patient was a 47-year-old male diagnosed with the dilated phase of hypertrophic cardiomyopathy. He had undergone heart transplantation (HTx) at the age of 43 years, and postoperative coronary angiography had shown no significant stenosis. However, intravascular ultrasound (IVUS) revealed that the maximal intimal thickness (MIT) of the left anterior descending artery (LAD) had progressed from 0.63 mm (at 1 month) to 1.15 mm (at 2 years) (Supplementary Figure A,B), and near-infrared spectroscopy (NIRS) IVUS at 2 years showed yellow signals with a maximum lipid core burden index in a 4-mm segment (max-LCBI) of 71 (Figure A). Based on these findings, we switched the immunosuppressive agent from mycophenolate mofetil to everolimus to suppress endometrial hyperplasia. IVUS at 3 years showed regression of the MIT in the LAD from 1.15 mm to 0.89 mm (Supplementary Figure C), and NIRS-IVUS demonstrated a significant reduction in yellow signals (Figure B). At 4 years, IVUS showed no evidence of progression of cardiac allograft vasculopathy (CAV) (Figure C, Supplementary Figure D).
Serial changes on NIRS-IVUS: (A) 2 years, (B) 3 years, and (C) 4 years after heart transplantation (HT). LCBI, lipid core burden index; NIRS-IVUS, near-infrared spectroscopy intravascular ultrasound.
NIRS-IVUS was originally developed to assess the composition of atherosclerotic plaques.1 A previous study showed that even a very low max-LCBI value (<100) was associated with accelerated plaque burden, which in patients with HTx might reflect an immunologic reaction, when compared with patients with atherosclerosis.2 Our case demonstrates that NIRS-IVUS may be useful for assessing the therapeutic effect of changing immunosuppressive agents to control CAV.
Drs. Anzai and Nagai are members of Circulation Journal’s Editorial Team.
Please find supplementary file(s);
https://doi.org/10.1253/circj.CJ-24-0024
