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Published on: August 28, 2018
Quantitative coronary computed tomography angiography for the detection of cardiac allograft vasculopathy
Borek Foldyna1,2,3, Marcus Sandri4, Christian Luecke5
1Department of Interventional and Diagnostic Radiology, University of Leipzig - Heart Center, Struempellstrasse 39, 04289, Leipzig, Germany. bfoldyna@mgh.harvard.edu.
Insights
Coronary computed tomography angiography (CTA) can detect cardiac allograft vasculopathy (CAV) in heart-transplanted (HTX) patients. CTA-derived coronary wall volume-length ratio, wall burden, and fibrotic tissue proportion identify early CAV, potentially aiding detection beyond invasive coronary angiography (ICA).
Area of Science:
- Cardiology
- Radiology
- Transplantation Medicine
Background:
- Cardiac allograft vasculopathy (CAV) is a major cause of graft failure in heart-transplanted (HTX) patients.
- Early detection of CAV is crucial for timely intervention and improved patient outcomes.
- Invasive coronary angiography (ICA) is the current standard for CAV detection but may miss early stages.
Purpose of the Study:
- To associate coronary wall volume and composition, derived from coronary computed tomography angiography (CTA), with CAV detected on ICA in HTX patients.
- To evaluate the diagnostic performance of CTA-derived parameters in identifying CAV.
- To assess the concordance between CTA and ICA in CAV detection.
Main Methods:
- Adult HTX patients undergoing both ICA and coronary CTA for CAV evaluation were included.
- Coronary segments were analyzed for lumen and wall volumes, calculating volume-length ratio (VLR) and wall burden (WB).
- Proportions of different tissue types within the coronary wall were assessed, and CTA measures were correlated with CAV presence on ICA.
Main Results:
- Segmental VLR, WB, and fibrotic tissue proportion were independently associated with CAV (OR = 1.06-1.27; p ≤ 0.002).
- The combination of these three parameters showed high discriminatory capacity (AUC = 0.84).
- CTA demonstrated higher concordance with ICA in advanced CAV, but also identified coronary wall changes without luminal stenosis in a significant proportion of segments.
Conclusions:
- CTA-derived coronary wall VLR, WB, and fibrotic tissue proportion are independent markers of CAV in HTX patients.
- The combination of these CTA parameters may aid in detecting early CAV stages missed by ICA.
- Coronary CTA offers a valuable non-invasive tool for comprehensive CAV assessment in HTX recipients.
Objectives:
To associate coronary wall volume and composition, derived from coronary computed tomography angiography (CTA), with cardiac allograft vasculopathy (CAV) detected on invasive coronary angiography (ICA) in heart-transplanted (HTX) patients.
Methods:
We included consecutive adults who received ICA and coronary CTA for evaluation of CAV ≥ 10 months after HTX. In all coronary segments, we assessed lumen and wall volumes and segmental length, calculated volume-length ratio (VLR) (volumes indexed by segmental length; mm3/mm), wall burden (WB) (wall/wall + lumen volumes; %), and assessed proportions of calcified, fibrotic, fibro-fatty, and low-attenuation tissue (%) in coronary wall. We rendered independent CTA measures associated with CAV by ICA, tested their discriminatory capacity, and assessed concordance between CTA and ICA.
Results:
Among 50 patients (84% men; 53.6 ± 11.9 years), we analyzed 632 coronary segments. Mean interval between HTX and CTA was 6.7 ± 4.7 years and between ICA and CTA 1 (0-1) day. Segmental VLR, WB, and proportion of fibrotic tissue were independently associated with CAV (OR = 1.06-1.27; p ≤ 0.002), reaching a high discriminatory capacity (combination of all three: AUC = 0.84; 95%CI, 0.75-0.90). Concordance between CTA and ICA was higher in advanced CAV (88%) compared with that in none (37%) and mild (19%) CAV. Discordance was primarily driven by a large number of segments with coronary wall changes on CTA but without luminal stenoses on ICA (177/591; 25%).
Conclusion:
CTA-derived coronary wall VLR, WB, and the proportion of fibrotic tissue are independent markers of CAV. Combination of these three parameters may aid the detection of early CAV not detected by ICA, the current standard of care.
Key Points:
• Coronary CTA detects CAV in HTX patients. • Coronary wall volume-length ratio, wall burden, and proportion of fibrotic tissue are independently associated with CAV. • In contrast to ICA, coronary CTA may identify the early stages of CAV.
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