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Published on: August 28, 2018
Temporal changes in coronary artery calcium in heart transplantation patients
Simran P Sharma1,2, Britt C J van Dijk1,2,3, Daniel Bos2,4
1Department of Cardiology, Cardiovascular Institute, Thorax Center, Erasmus MC, Rotterdam, The Netherlands.
Insights
Coronary artery calcium (CAC) progression is common after heart transplantation (HT), particularly with increasing donor heart age. Monitoring CAC may help tailor cardiovascular management for HT recipients.
Area of Science:
- Cardiology
- Transplantation Medicine
- Radiology
Background:
- Coronary artery calcium (CAC) scoring assesses atherosclerotic burden.
- Limited data exists on CAC progression and its clinical impact in heart transplant (HT) recipients.
- Long-term follow-up of CAC in HT patients is crucial for understanding cardiovascular risk.
Purpose of the Study:
- To evaluate the progression of coronary artery calcium (CAC) in heart transplant (HT) recipients.
- To identify factors associated with CAC progression post-HT.
- To provide insights into cardiovascular disease progression and risk stratification in HT patients.
Main Methods:
- Retrospective analysis of adult HT recipients with at least 5 years post-transplant and 4 years of annual cardiac CT follow-up.
- CAC scores assessed via non-contrast CT, categorizing patients into no progression or any increase.
- Generalized linear mixed models and logistic regression used to analyze temporal CAC changes and associated variables.
Main Results:
- Over half (65/116) of HT recipients showed CAC progression.
- An average annual increase in Ln(CAC+1) of 0.4 was observed, representing a 55% relative yearly increase.
- Donor heart age was independently associated with CAC progression; recipient age, sex, and ischemic cardiomyopathy also influenced progression rates.
Conclusions:
- CAC progression is a common finding in HT recipients.
- Donor heart age is the strongest predictor of CAC progression.
- Findings suggest closer surveillance and aggressive cardiovascular management for HT patients, especially those with risk factors like younger donor age, male sex, and ischemic cardiomyopathy.
Objectives:
Coronary artery calcium (CAC) scoring is a well-established marker of atherosclerotic burden in the general population. Limited research has examined CAC progression and clinical implications in heart transplant (HT) recipients. We evaluated CAC progression in HT patients during long-term follow-up.
Materials And Methods:
We included adult HT recipients (≥ 5 years post-HT) from a retrospective single-center cohort undergoing annual cardiac CT with ≥ 4 years of follow-up. CAC scores were assessed using non-contrast CT. Patients were classified into two groups: no CAC progression (CAC = 0 across all CT scans) or any increase in CAC during follow-up. Generalized linear mixed models evaluated temporal changes in CAC; logistic regression identified variables associated with CAC progression.
Results:
Among 116 patients (median age at baseline CT: 52 [38-63] years, 62% male), 65 showed CAC progression. From baseline to final CT, the proportion of patients with cardiac allograft vasculopathy (CAV) score 0 declined (90-83%), while CAV 1 and 3 increased (3-6%; 8-11%). CAC scores showed an annual increase in Ln(CAC + 1) of 0.4 (95% CI: 0.4-0.5; p < 0.001), corresponding to a 55% relative yearly increase. Significant interactions were found with recipient age at baseline CT (p = 0.008), donor heart age (p < 0.001), sex (p = 0.024), and recipient ischemic cardiomyopathy (p < 0.001). Only donor heart age was independently associated with CAC progression (p < 0.001).
Conclusion:
CAC progression is common post-HT, with donor heart age showing the strongest association. Younger recipient and donor heart age, male sex, and ischemic cardiomyopathy were associated with faster CAC progression, suggesting the need for closer surveillance and more aggressive cardiovascular management.
Key Points:
Question Longitudinal changes in CAC score were assessed in HT recipients to provide insights into cardiovascular risk and disease progression. Findings Over half of HT recipients showed CAC progression, which was significantly associated with donor age. Recipient age, sex, and primary diagnosis influenced progression rate. Clinical relevance Routine CAC monitoring may help identify patients at higher risk of cardiovascular events after heart transplantation, allowing for closer surveillance and more aggressive cardiovascular management, which in turn might improve long-term outcomes.
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