Redefining CAV surveillance strategies: Benefits of CCTA vs. ICA
Valeria Pergola1, Nicola Pradegan2, Elena Cozza1
1Cardiology Unit, Cardio-thoraco-vascular and Public Health Department, Padova University Hospital, Padova, Italy.
Insights
Cardiac computed tomography angiography (CCTA) offers a safe, cost-effective, and less burdensome alternative to invasive coronary angiography for cardiac allograft vasculopathy surveillance after heart transplantation.
Area of Science:
- Cardiology
- Transplantation Medicine
- Medical Imaging
Background:
- Cardiac allograft vasculopathy (CAV) surveillance post-heart transplantation (HT) traditionally uses invasive coronary angiography (ICA).
- Cardiac computed tomography angiography (CCTA) presents a potential alternative with economic, safety, and logistical advantages.
Purpose of the Study:
- To evaluate the impact of a CCTA program on economic, safety, and logistical aspects of CAV surveillance post-HT.
- To compare CCTA with ICA for CAV surveillance in heart transplant recipients.
Main Methods:
- Retrospective single-center study from March 2021 to February 2023.
- Involved heart transplant patients undergoing either CCTA or ICA for CAV surveillance.
- Compared outcomes between the CCTA and ICA groups.
Main Results:
- 115 patients underwent CCTA, and 145 underwent ICA.
- CCTA group demonstrated significantly lower overall costs and shorter hospitalization times (p<0.0001).
- CCTA required less contrast volume (p<0.0001) and lower effective radiation doses (p=0.03) compared to ICA.
Conclusions:
- CCTA is a safe, cost-effective, and non-invasive alternative for CAV surveillance post-HT.
- CCTA outperforms ICA in safety, logistics, and economic burden.
- CCTA facilitates improved patient management and resource utilization in heart transplant recipients.
Background:
Cardiac allograft vasculopathy (CAV) assessment post-heart transplantation (HT) typically relies on invasive coronary angiography (ICA). However, cardiac computed tomography angiography (CCTA) is emerging as a promising alternative due to its potential benefits in economic, safety, and logistical aspects. This study aimed to evaluate the impact of a CCTA program on these aspects in CAV surveillance post-HT.
Methods:
A retrospective single-center study was conducted between March 2021 and February 2023, involving HT patients who underwent either CCTA or ICA.
Results:
Among 260 patients undergoing CAV surveillance, 115 (44.2%) patients underwent CCTA, and 145 (55.8%) patients underwent ICA. The CCTA group showed incurred lower overall costs (p < 0.0001) and shorter hospitalization times (p < 0.0001) compared to the ICA group. In terms of safety, CCTA surveillance required significantly lower contrast volumes (p < 0.0001) and lower effective doses (p = 0.03).
Conclusion:
CCTA emerges as a safe and cost-effective non-invasive alternative for CAV surveillance post-HT, outperforming ICA in terms of safety, logistical aspects, and economic burden.
