(458) - Safety of Intravascular Ultrasound in Nearly 900 Cases

Abstract

Purpose: Coronary intravascular ultrasound (IVUS) can detect evidence of cardiac allograft vasculopathy with much higher sensitivity than coronary angiography in transplant recipients. However, in randomized trials fewer than a third of patients usually undergo this procedure due to renal dysfunction or perceived risk of the intervention. At a single large transplant center, IVUS has been available since 2006. With increasing familiarity, the application of this technique has grown and now includes patients with significant renal dysfunction. The procedural and renal safety of IVUS is described below. Methods: 892 consecutive IVUS examinations were performed for 354 adult heart transplant recipients from 2006-2013. Cardiac biopsy was performed immediately prior to coronary angiography and IVUS in 65 % of the cases. The Boston Scientific Atlantis Pro SR catheter was utilized in all cases after therapeutic anticoagulation and administration of intracoronary nitroglycerin. Results: The table details the utilization of contrast and the baseline renal function of patients undergoing IVUS examinations. Analysis of baseline serum creatinine across the year categories demonstrated a trend to reduced renal function at the time of IVUS exam (p= 0.06), but a highly significant reduction in contrast dose over time (p< 0.0001). Regardless of time period, there was no significant change in serum creatinine or GFR following IVUS examination. The 90 % quantile and maximum serum creatinines are tabulated below. Even patients with significant renal impairment (creatinine over 1.9 mg/dl) underwent IVUS successfully. There were no complications such as pericardial tamponade, nor any new-onset renal replacement therapy.Conclusion: IVUS can be safely performed in cardiac transplant recipients with a low dose of contrast, at the time of myocardial biopsy, and without significant risk of contrast-induced nephropathy.