Optical Coherence Tomography (OCT) is an intravascular imaging modality enabling detailed evaluation of cardiac allograft vasculopathy (CAV) after heart transplantation (HTx). However, its clinical application remains hampered by time-consuming manual quantitative analysis. We aimed to validate a semi-automated quantitative OCT analysis software (Iowa Coronary Wall Analyzer, ICWA-OCT) to improve OCT-analysis in HTx patients. 23 patients underwent OCT evaluation of all three major coronary arteries at 3 months (3M) and 12 months (12M) after HTx. We analyzed OCT recordings using the semiautomatic software and compared results with measurements from a validated manual software. For semi-automated analysis, 31,228 frames from 114 vessels were available. The validation was based on a subset of 4287 matched frames. We applied mixed model statistics to accommodate the multilevel data structure with method as a fixed effect. Lumen (minimum, mean, maximum) and media (mean, maximum) metrics showed no significant differences. Mean and maximum intima area were underestimated by the semi-automated method (β-methodmean = - 0.289 mm2, p < 0.01; β-methodmax = - 0.695 mm2, p < 0.01). Bland-Altman analyses showed increasing semi-automatic underestimation of intima measurements with increasing intimal extent. Comparing 3M to 12M progression between methods, mean intimal area showed minor underestimation (β-methodmean = - 1.03 mm2, p = 0.04). Lumen and media metrics showed excellent agreement between the manual and semi-automated method. Intima metrics and progressions from 3M to 12M were slightly underestimated by the semi-automated OCT software with unknown clinical relevance. The semi-automated software has the future potential to provide robust and time-saving evaluation of CAV progression.

Department of Cardiology Aarhus University Hospital Palle Juul Jensens Boulevard 99 8200 Aarhus N entrance F Aarhus Denmark

Department of Cardiology Institute for Clinical and Experimental Medicine Prague Czech Republic

Department of Clinical Medicine Aarhus University Aarhus Denmark

Iowa Institute for Biomedical Imaging University of Iowa L300 Pappajohn Biomedical Discovery Building 169 Newton Road Iowa City IA 52242 USA

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Clemmensen TS et al. (2013) Twenty years’ experience at the Heart Transplant Center, Aarhus University Hospital, Skejby Denmark. Scand Cardiovasc J 47(6):322–328 PubMed

Stehlik J et al. (2018) Honoring 50 years of clinical heart transplantation in circulation: in-depth state-of-the-art review. Circulation 137(1):71–87 PubMed

Khush KK et al. (2019) The international thoracic organ transplant registry of the international society for heart and lung transplantation: thirty-sixth adult heart transplantation report—2019; focus theme: donor and recipient size match. J Heart Lung Transpl 38(10):1056–1066 PubMed PMC

Clemmensen TS, Jensen NM, Eiskjær H (2021) Imaging of cardiac transplantation: an overview. Semin Nucl Med 51(4):335–348 PubMed

St Goar FG et al. (1992) Intracoronary ultrasound in cardiac transplant recipients. In vivo evidence of “angiographically silent” intimal thickening. Circulation 85(3):979–987 PubMed

Andreassen AK et al. (2014) Everolimus initiation and early calcineurin inhibitor withdrawal in heart transplant recipients: a randomized trial. Am J Transpl 14(8):1828–1838 PubMed

Logani S et al. (2011) Clinical utility of intravascular ultrasound in the assessment of coronary allograft vasculopathy: a review. J Interv Cardiol 24(1):9–14 PubMed

Potena L et al. (2015) Interplay of coronary angiography and intravascular ultrasound in predicting long-term outcomes after heart transplantation. J Heart Lung Transpl 34(9):1146–1153 PubMed

Khandhar SJ et al. (2013) Optical coherence tomography for characterization of cardiac allograft vasculopathy after heart transplantation (OCTCAV study). J Heart Lung Transpl 32(6):596–602 PubMed

Tahara S et al. (2011) In vitro validation of new Fourier-domain optical coherence tomography. EuroIntervention 6(7):875–882 PubMed

Okamura T et al. (2010) Reproducibility of coronary Fourier domain optical coherence tomography: quantitative analysis of in vivo stented coronary arteries using three different software packages. EuroIntervention 6(3):371–379 PubMed

Clemmensen TS et al. (2018) Detection of early changes in the coronary artery microstructure after heart transplantation: a prospective optical coherence tomography study. J Heart Lung Transpl 37(4):486–495 PubMed

Pazdernik M et al. (2018) Early detection of cardiac allograft vasculopathy using highly automated 3-dimensional optical coherence tomography analysis. J Heart Lung Transpl 37(8):992–1000 PubMed

Imamura T et al. (2014) Cardiac allograft vasculopathy can be distinguished from donor-transmitted coronary atherosclerosis by optical coherence tomography imaging in a heart transplantation recipient: double layered intimal thickness. Int Heart J 55(2):178–180 PubMed

Clemmensen TS et al. (2017) Layered fibrotic plaques are the predominant component in cardiac allograft vasculopathy: systematic findings and risk stratification by OCT. JACC Cardiovasc Imaging 10(7):773–784 PubMed

Acharya D et al. (2021) Optical coherence tomography in cardiac allograft vasculopathy: state-of-the-art review. Circ Heart Fail 14(9):e008416. PubMed

Chen Z et al. (2018) Quantitative 3D analysis of coronary wall morphology in heart transplant patients: OCT-assessed cardiac allograft vasculopathy progression. Med Image Anal 50:95–105 PubMed PMC

Wu X, Garvin MK, Sonka M (2012) Optimal simultaneous multi-surface and multi-object image segmentation. In: Lézoray O, Grady L (eds) Image processing and analyzing with graphs: theory and practice. CRC Press, Boca Raton, pp 265–304

Zhang HL (2020) Kyungmoo; Chen Zhi; Kashyap Satyananda; Sonka Milan, LOGISMOS-JEI: Segmentation using optimal graph search and just-enough interaction, Handbook of medical image computing and computer assisted intervention. Academic press, London

Sun S, Sonka M, Beichel RR (2013) Graph-based IVUS segmentation with efficient computer-aided refinement. IEEE Trans Med Imaging 32(8):1536–1549 PubMed PMC

Koning G et al. (2002) Advanced contour detection for three-dimensional intracoronary ultrasound: a validation–in vitro and in vivo. Int J Cardiovasc Imaging 18(4):235–248 PubMed

Rabe-Hesketh S, Skrondal A (2008) Multilevel and Longitudinal Modeling Using Stata, 2nd edn. Stata Press, College Station

Grubić Rotkvić P et al. (2020) Prevention of cardiac allograft vasculopathy—a new possible indication for SGLT-2 inhibitors? Med Hypotheses 137:109594. PubMed

Acetylsalicylic acid use and development of cardiac allograft vasculopathy: A national prospective study using highly automated 3-D optical coherence tomography analysis