Optical coherence tomography for characterization of cardiac allograft vasculopathy in late survivors of pediatric heart transplantation

Tomai, Fabrizio; Luca, Leonardo De; Petrolini, A.; Vito, Luca Di; Ghini, Anna S.; Corvo, Pierfrancesco; Persio, Giovanni De; Parisi, Francesco; Pongiglione, Giacomo; Gagliardi, Maria Giulia; Prati, Francesco

doi:10.1016/j.healun.2015.08.011

Cited by 25 publications

(9 citation statements)

References 27 publications

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“…MRI is being trialed in a few centers but has yet to reach the level of replacing angiography, either from an imaging perspective or, more recently, microcirculation assessment (52). Optical coherence tomography has been tried in a few centers as a supplementary tool, but has not achieved widespread application in pediatrics (53).…”

Section: Cavmentioning

confidence: 99%

Current state of pediatric cardiac transplantation

Dipchand

2018

Ann. Cardiothorac. Surg.

109

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Pediatric heart transplantation is standard of care for children with end-stage heart failure. The diverse age range, diagnoses, and practice variations continue to challenge the development of evidence-based practices and new technologies. Outcomes in the most recent era are excellent, especially with the more widespread use of ventricular assist devices (VADs). Waitlist mortality remains high and knowledge of risk factors for death while waiting and following transplantation contributes to decision-making around transplant candidacy and timing of listing. The biggest gap impacting both waitlist and overall survival remains mechanical support options for infants and patients with single ventricle physiology. Though acute rejection has decreased progressively, both diagnosis and management of antibody-mediated rejection has become increasingly challenging and complex, as has the ability to understand the implication of anti-HLA antibodies detected both pre-and post-transplantation-including when and how to intervene. Trends in immunosuppression protocols include more use of induction therapy and steroid avoidance or withdrawal protocols. Common long-term morbidities include renal insufficiency, which can be mitigated with surveillance and renal-sparing strategies, and infections. Functional outcomes are excellent, but significant psychosocial challenges exist in relation to neurodevelopment, non-adherence, and transition from childcentered to adult-centered care. Cardiac allograft vasculopathy (CAV) remains a barrier to long-term survival, though it is more apparent that objective evidence of an impact on the allograft is important with regards to impact on outcomes. Retransplantation is rare in pediatric heart transplant recipients. Pediatric heart transplantation continues to evolve in order to address the challenges of the diverse group of patients that reach end-stage heart failure during childhood.

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Section: Cavmentioning

confidence: 99%

Current state of pediatric cardiac transplantation

Dipchand

2018

Ann. Cardiothorac. Surg.

109

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“…Pediatric data is limited; however, a study in 73 children after HT (258 vessel segments) showed a high prevalence of segmental and eccentric intimal thickening [70]. However, another study in late survivors after pediatric HT reported that OCT findings of vulnerable plaque and complicated coronary lesions are rare, in contrast with adult HT recipients [71]. Further prospective and more extensive studies are needed to study the clinical utility of OCT to demonstrate its prognostic implications in children.…”

Section: Optical Coherence Tomographymentioning

confidence: 99%

Multimodality Imaging to Detect Rejection, and Cardiac Allograft Vasculopathy in Pediatric Heart Transplant Recipients—An Illustrative Review

Das

Deshpande

Hussain³

2022

Transplantology

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The three most common modalities of graft surveillance in pediatric heart transplant (HT) recipients include echocardiography, coronary angiography, and endomyocardial biopsy (EMB). The survival outcomes after HT in children have improved considerably in recent years. However, allograft rejection and cardiac allograft vasculopathy remain the leading cause of death or re-transplantation. The routine surveillance by EMB and coronary angiography are invasive and risky. Newer noninvasive echocardiographic techniques, including tissue Doppler imaging (TDI), 2-D speckle tracking echocardiography, CT coronary angiography (CTCA), cardiovascular magnetic resonance (CMR), single-photon emission computed tomography (SPECT), and positron emission tomography (PET) and invasive techniques such as intravascular ultrasound (IVUS), functional flow reserve (CFR) of coronary arteries, optical coherence tomography (OCT), have emerged as powerful tools which may help early recognition of sub-clinical rejection, response to treatment, early detection, and progression of CAV. The multimodality imaging approach, including noninvasive and invasive tests, is the future for the transplanted heart to detect dysfunction, rejections, and early CAV. This review illustrates noninvasive and invasive imaging techniques currently used or could be considered for clinical use in detecting heart transplant rejection, dysfunction, and CAV in children.

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“…Computerized texture analysis has not been previously explored for analysis of OCTA images, and evidence suggests that it can offer discrimination of spectral data beyond the naked eye through comparison of light and dark to include second-order statistical information regarding pixel correlation, skew, and coarseness [ 40 , 41 ]. Furthermore, quantitative analysis of OCT/OCTA imaging has been used in wide-ranging fields in biology and medicine for the characterization of imaging features found to correlate with histology, suggesting a role for texture analysis of OCTA images of the choriocapillaris [ 42 , 43 , 44 , 45 ]. Given the clinical significance of the CC and the current challenges in analyzing and interpreting OCTA images of this layer with widely available technology, we investigated the feasibility of applying computerized texture analysis to en-face OCTA imaging of the CC of normal subjects to extract quantitative metrics representing the texture of vascular patterns/perfusion.…”

Section: Introductionmentioning

confidence: 99%

Computerized Texture Analysis of Optical Coherence Tomography Angiography of Choriocapillaris in Normal Eyes of Young and Healthy Subjects

Movahedan

Vargas

Moir

et al. 2022

Cells

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Computerized texture analysis uses higher-order mathematics to identify patterns beyond what the naked eye can recognize. We tested its feasibility in optical coherence tomography angiography imaging of choriocapillaris. Our objective was to determine sets of parameters that provide coherent and consistent output when applied to a homogeneous, healthy group of patients. This observational cross-sectional study involved 19 eyes of 10 young and healthy Caucasian subjects. En-face macular optical coherence tomography angiography of superficial choriocapillaris was obtained by the RTVue-XR Avanti system. Various algorithms were used to extract texture features. The mean and standard deviation were used to assess the distribution and dispersion of data points in each metric among eyes, which included: average gray level, gray level yielding 70% threshold and 30% threshold, balance, skewness, energy, entropy, contrast, edge mean gradient, root-mean-square variation, and first moment of power spectrum, which was compared between images, showing a highly concordant homology between all eyes of participants. We conclude that computerized texture analysis for en-face optical coherence tomography angiography images of choriocapillaris is feasible and provides values that are coherent and tightly distributed around the mean in a homogenous, healthy group of patients. Homology of blob size among subjects may represent a “repeat pattern” in signal density and thus a perfusion in the superficial choriocapillaris of healthy young individuals of the same ethnic background.

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Optical coherence tomography for characterization of cardiac allograft vasculopathy in late survivors of pediatric heart transplantation

Cited by 25 publications

References 27 publications

Current state of pediatric cardiac transplantation

Current state of pediatric cardiac transplantation

Multimodality Imaging to Detect Rejection, and Cardiac Allograft Vasculopathy in Pediatric Heart Transplant Recipients—An Illustrative Review

Computerized Texture Analysis of Optical Coherence Tomography Angiography of Choriocapillaris in Normal Eyes of Young and Healthy Subjects

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