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Computed tomography imaging of cardiac allograft vasculopathy
Maros Ferencik1, Thomas J Brady, Udo Hoffmann
1Cardiology Division, Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Boston, MA 02114, USA. maros_ferencik@hms.harvard.edu
Insights
Cardiac allograft vasculopathy (CAV) screening using computed tomography (CT) shows promise. CT can serve as a gatekeeper, potentially reducing the need for invasive procedures in heart transplant recipients.
Area of Science:
- Cardiology
- Radiology
- Transplantation Medicine
Background:
- Cardiac allograft vasculopathy (CAV) is a primary cause of death after heart transplantation, often presenting with heart failure or sudden cardiac death due to its diffuse nature and lack of ischemic symptoms.
- Current screening relies on invasive coronary angiography (ICA) and echocardiography, but noninvasive methods for CAV detection are underutilized.
Purpose of the Study:
- To review the literature on the use of computed tomography (CT) for evaluating cardiac allograft vasculopathy (CAV) in heart transplant recipients.
- To highlight technical challenges and solutions for cardiac CT in this patient population and assess its diagnostic performance.
Main Methods:
- Systematic literature review focusing on studies evaluating cardiac CT for coronary stenoses detection compared to ICA.
- Analysis of studies comparing CT with intravascular ultrasound for nonobstructive CAV detection.
Main Results:
- Computed tomography (CT) demonstrates a high negative predictive value for detecting coronary stenoses, positioning it as a potential gatekeeper test.
- Technical challenges in cardiac CT for heart transplant recipients, such as high heart rates and image quality, are being addressed by new technologies and protocols.
Conclusions:
- Cardiac CT shows potential as a noninvasive tool for screening cardiac allograft vasculopathy (CAV), offering a high negative predictive value.
- Further research into cardiac CT imaging is recommended to optimize its role in managing heart transplant recipients and detecting CAV.
Abstract:
Cardiac allograft vasculopathy (CAV) is the main cause of morbidity and mortality beyond 1 year after heart transplantation. Ischemic symptoms are usually not present because of the denervated allograft and diffuse nature of the disease. Patients present with heart failure, ventricular arrhythmia, or sudden cardiac death as a result of advanced CAV. Therefore, clinical evaluation includes routine annual invasive coronary angiography (ICA) and transthoracic echocardiography to screen for CAV. Noninvasive imaging methods for the detection of CAV have not been widely adopted. Computed tomography (CT) permits detection of coronary stenoses and plaque in the nontransplant population. The strength of CT is its high negative predictive value. These attributes predispose CT to a role of a gatekeeper for further invasive testing in heart transplant recipients. We reviewed the available literature on CT evaluation of CAV. Technical challenges (eg, high heart rates, need for contrast and radiation, image quality) specific for patients who have received a heart transplant are emphasized, and solutions, including appropriate protocols and advances through the new CT technology, are summarized. We systematically analyze the results of studies that report the diagnostic performance of cardiac CT for the detection of coronary stenoses compared with ICA. Similar analysis is performed for the comparison between CT and intravascular ultrasound scanning for the detection of nonobstructive CAV. Finally, we suggest future directions in cardiac CT imaging research of CAV.
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