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Utility of 64-Slice Coronary Computed Tomography Angiography in Heart Transplant Recipients
Agnieszka Kuczaj1, Szymon Pawlak1, Jan Głowacki2
1Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland; Silesian Center for Heart Diseases, Zabrze, Poland.
Insights
Coronary computed tomographic angiography (CCTA) is a safe and effective tool for assessing heart transplant recipients for cardiac allograft vasculopathy (CAV). This non-invasive imaging method helps identify significant changes, guiding further treatment and improving patient outcomes.
Area of Science:
- Cardiology
- Radiology
- Transplantation Medicine
Background:
- Graft vasculopathy, or cardiac allograft vasculopathy (CAV), is a primary cause of mortality following heart transplantation (HTx).
- Diagnosing CAV in HTx patients presents considerable clinical challenges.
- This study evaluated coronary computed tomographic angiography (CCTA) for safety and efficacy in post-HTx patients.
Purpose of the Study:
- To assess the safety and diagnostic performance of CCTA in heart transplant recipients.
- To determine if CCTA can reliably detect or exclude significant cardiac allograft vasculopathy.
- To evaluate CCTA as a non-invasive tool for routine follow-up in HTx patients.
Main Methods:
- 107 heart transplant recipients (≥3 years post-transplant) with minimal/no prior CAV evidence underwent 64-slice CCTA.
- Inclusion criteria: eGFR ≥30, no new heart failure symptoms, no contrast/CT contraindications.
- Noninvasive follow-up for minimal changes; coronary angiography for significant CT findings.
Main Results:
- 98/107 patients showed no significant changes on CCTA, excluding significant CAV.
- 8/9 patients with suspected significant CAV on CCTA had confirmed changes, with 6 undergoing percutaneous transluminal coronary angioplasty (PTCA).
- No cardiovascular events occurred in the negative CCTA group; one death post-PTCA in the positive group. Stable ejection fraction and eGFR observed.
Conclusions:
- CCTA is a safe and effective imaging modality for evaluating heart transplant recipients.
- CCTA can reliably identify or exclude significant cardiac allograft vasculopathy.
- This technique offers a valuable non-invasive approach for managing HTx patients.
Background:
Graft vasculopathy is a leading cause of death after heart transplantation (HTx). Diagnosing cardiac allograft vasculopathy (CAV) within this patient group poses significant challenges. This study aimed to evaluate the safety and efficacy of coronary computed tomographic angiography (CCTA) in patients after HTx.
Methods:
We enrolled 107 consecutive HTx recipients (26 women, mean age 50 ± 17 years); all were ≥3 years post-HTx with minimal or no evidence of CAV in a prior coronary angiography performed a minimum of 2 years before the current examination. The inclusion criteria comprised an estimated glomerular filtration rate (eGFR) of ≥30, absence of new heart failure symptoms, and no contraindications to iodine contrast or CT scans. All patients underwent a 64-slice CCTA. In cases of minimal or no changes, noninvasive follow-up examinations were conducted. Significant changes in CT prompted additional coronary angiography.
Results:
Of the enrolled participants, 9 exhibited minimal changes; 98 displayed no changes in coronary angiography. The median time since transplant was 7 years, with IQR of 4 to 11.25 years. Significant changes were excluded in 98 patients. Among the 9 patients with suspected significant CAV, significant changes were confirmed in 8 patients, resulting in percutaneous transluminal coronary angioplasty (PTCA) performed in 6. One patient from this group died shortly after PTCA. No cardiovascular incidents were observed within the remaining group. The median follow-up period was 539 (IQR = 289-654 days). The mean left ventricular ejection fraction at follow-up was 58% ± 5% compared with 58% ± 4% at baseline. At follow-up, the mean eGFR was 64 ± 18 mL/kg/1.73 m2 compared with the baseline value of 67.2 mL/kg/1.73 m2.
Conclusions:
CCTA appears to offer a secure and efficient means of assessment in HTx recipients.
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