scholarly journals Clinical implementation of coronary computed tomography angiography for routine detection of cardiac allograft vasculopathy in heart transplant patients

2021 ◽  
Author(s):  
Fay M.A. Nous ◽  
Stefan Roest ◽  
Eva D. van Dijkman ◽  
Mohamed Attrach ◽  
Kadir Caliskan ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Heart Transplant ◽  
Computed Tomography Angiography ◽  
Coronary Computed Tomography Angiography ◽  
Cardiac Allograft Vasculopathy ◽  
Cardiac Allograft ◽  
Clinical Implementation ◽  
Allograft Vasculopathy ◽  
Coronary Computed Tomography ◽  
Transplant Patients

Coronary computed tomography in heart transplant patients: detection of significant stenosis and cardiac allograft vasculopathy, image quality, and radiation dose

2017 ◽  
Vol 59 (9) ◽  
pp. 1066-1073 ◽  
Author(s):  
Anne Günther ◽  
Lars Aaberge ◽  
Andreas Abildgaard ◽  
Asgrimur Ragnarsson ◽  
Thor Edvardsen ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Coronary Artery ◽  
Image Quality ◽  
Radiation Dose ◽  
Heart Transplant ◽  
Cardiac Allograft Vasculopathy ◽  
Cardiac Allograft ◽  
Allograft Vasculopathy ◽  
Significant Stenosis ◽  
Coronary Computed Tomography

Background Cardiac allograft vasculopathy (CAV) is an accelerated form of atherosclerosis unique to heart transplant (HTX) patients. Purpose To investigate the detection of significant coronary artery stenosis and CAV, determinants of image quality, and the radiation dose in coronary computed tomography angiography (CCTA) of HTX patients with 64-slice multidetector CT (64-MDCT). Material and Methods Fifty-two HTX recipients scheduled for invasive coronary angiography (ICA) were prospectively enrolled and underwent CCTA before ICA with intravascular ultrasound (IVUS). Results Interpretable CCTA images were acquired in 570 (95%) coronary artery segments ≥2 mm in diameter. Sensitivity, specificity, and positive and negative predictive values of CCTA for the detection of segments with significant stenosis (lumen reduction ≥50%) on ICA were 100%, 98%, 7.7%, and 100%, respectively. Twelve significant stenoses were located in segments with uninterpretable image quality or vessel diameter <2 mm; only one was eligible for intervention. IVUS detected CAV (maximal intimal thickness ≥0.5 mm) in 33/41 (81%) patients; CCTA and ICA identified CAV (any wall or luminal irregularity) in 18 (44%) and 14 (34%) of these 33 patients, respectively. The mean estimated radiation dose was 19.0 ± 3.4 mSv for CCTA and 5.7 ± 3.3 mSv for ICA ( P < 0.001). Conclusion CCTA with interpretable image quality had a high negative predictive value for ruling out significant stenoses suitable for intervention. The modest detection of CAV by CCTA implied a limited value in identifying subtle CAV. The high estimated radiation dose for 64-MDCT is of concern considering the need for repetitive examinations in the HTX population.

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