Plaque characteristics in CAV evolve substantially over time, with later post-transplant years marked by more eccentric and calcified lesions. Published in the International Journal of Cardiology, this study examined long-term plaque behavior using serial VH-IVUS in heart-transplant recipients.

The analysis included 50 patients who underwent VH-IVUS at three intervals post-heart transplantation (HTx): A1 (0–1 year), A2 (3–5 years), and A3 (7–10 years). The mean age was 51 ± 13 years, and 72% were male. Plaque volume increased in both the early (A1–A2) and late (A2–A3) intervals, but the progression rate slowed significantly in the late phase (5.8% vs 2.4%; p = 0.015).

The EI decreased early but increased late (–0.040 vs 0.003; p = 0.036), indicating a transition toward more eccentric plaque morphology. At A3, patients with greater late EI increases had less fibrous plaque (p = 0.002) and more dense calcium (p = 0.022).

These findings show that CAV does not remain limited to concentric intimal thickening but gradually develops features resembling conventional atherosclerosis. The late-stage shift toward calcified, eccentric plaques suggests that treatment approaches derived from coronary artery disease management may benefit long-term heart-transplant care.