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Cardiac Allograft Vasculopathy Assessment in Heart-transplanted Patients: The Value of Cardiac Computed Tomography
Rasmus Gebauer Dalsgaard1, Hans Eiskjær1,2, Jesper Møller Jensen1
1Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
Insights
Cardiac computed tomography angiography (CCTA) effectively identifies cardiac allograft vasculopathy (CAV) in heart transplant recipients, showing high agreement with invasive methods and potential for early detection. This noninvasive approach aids in risk stratification for CAV progression.
Area of Science:
- Cardiology
- Radiology
- Transplantation Medicine
Background:
- Noninvasive assessment of cardiac allograft vasculopathy (CAV) is crucial for heart transplant recipients.
- Cardiac computed tomography angiography (CCTA) is being evaluated as a noninvasive tool for CAV detection.
- This study compares CCTA with invasive coronary angiography (ICA) and optical coherence tomography (OCT).
Purpose of the Study:
- To evaluate the feasibility and accuracy of CCTA for assessing CAV in heart transplant recipients.
- To determine the agreement between CCTA and ICA in diagnosing CAV.
- To correlate mild vessel wall changes detected by CCTA with OCT findings.
Main Methods:
- Prospective, observational, single-center study involving adult heart transplant recipients.
- Patients underwent CCTA prior to protocol ICA, with OCT performed on select vessels.
- CCTA and ICA were interpreted by blinded readers using ISHLT criteria; OCT provided quantitative metrics.
Main Results:
- CCTA achieved diagnostic quality in 98% of segments and identified CAV in 70% of patients, compared to 42% by ICA.
- The negative predictive value of CCTA for ICA-defined CAV was high (93% patient-level, 89% vessel-level).
- OCT confirmed mild vessel wall abnormalities in patients with CCTA-detected mild CAV, and moderate-to-severe CAV correlated with increased adverse events.
Conclusions:
- CCTA is a feasible and reliable method for CAV surveillance in heart transplant recipients.
- CCTA accurately identifies ICA-defined CAV and detects mild vessel wall changes, validated by OCT.
- CCTA holds potential for earlier noninvasive detection of CAV and improved risk stratification.
Background:
Noninvasive assessment of cardiac allograft vasculopathy (CAV) is desirable. This study evaluates cardiac computed tomography angiography (CCTA) for CAV assessment, including agreement with invasive coronary angiography (ICA), and correlation of mild vessel wall changes with optical coherence tomography (OCT).
Methods:
In this prospective, observational, single-center study, adult heart transplant (HTx) recipients underwent CCTA 1 wk before protocol ICA, with 3-vessel OCT performed when feasible. CCTA and ICA were graded by the International Society for Heart and Lung Transplantation (ISHLT) criteria by blinded readers. OCT provided quantitative vessel wall metrics. Major adverse cardiac events (heart failure hospitalization, CAV progression/percutaneous coronary intervention/occlusion, or cardiovascular death) were assessed.
Results:
Fifty patients (median age 51 y; 74% male; median 7.7 y post-HTx) completed imaging. CCTA provided diagnostic quality in 98% of segments and enabled classification in all patients. CCTA identified CAV in 70% of patients versus 42% by ICA. The negative predictive value (95% confidence interval) of CCTA for any ICA-defined CAV was 93% (68%-100%) at the patient level and 89% (81%-95%) at the vessel level. In patients with no CAV on ICA but with minor signs of CAV (ie, ISHLT class 1) on CCTA, OCT revealed lower lumen/intima ratio compared with patients without CCTA-detected CAV. Over a median 2.3-y follow-up, 18% experienced a major adverse cardiac event; risk was higher with moderate-to-severe CAV (ie, ISHLT class 2-3).
Conclusions:
CCTA is feasible for CAV surveillance in selected HTx recipients and reliably identifies ICA-defined CAV. CCTA also detects mild vessel wall abnormalities supported by OCT, suggesting potential value for earlier noninvasive CAV detection and risk stratification.
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