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Determinants of transplant-related coronary calcium detected by ultrafast computed tomography scanning
1Harefield Hospital, Royal Brompton National Heart and Lung Institute, Imperial College of Science, Technology and Medicine, London, United Kingdom.
Insights
Coronary calcium, a marker of heart disease, is common in heart transplant recipients. Its presence is linked to recipient dyslipoproteinemia, hypertension, and donor organ ischemic time, highlighting key risk factors.
Area of Science:
- Cardiology
- Transplant Medicine
- Radiology
Background:
- Coronary calcium is a marker for coronary artery disease.
- Its role in heart transplant recipients requires further investigation.
- Ultrafast computed tomography (CT) is used for detection.
Purpose of the Study:
- To identify determinants of coronary calcium post-heart transplantation.
- To analyze associations between coronary calcium and various patient/donor factors.
Main Methods:
- 102 heart transplant recipients underwent ultrafast CT and coronary angiography.
- Data collected included recipient demographics, medical history, lipid profiles, immunosuppression, and donor ischemic time.
- Statistical analyses (univariate and logistic regression) were performed.
Main Results:
- 45.1% of patients had detectable coronary calcium.
- Coronary calcium was associated with dyslipoproteinemia (high cholesterol, triglycerides, lipoprotein(a)).
- Logistic regression identified dyslipoproteinemia, systemic hypertension, and donor ischemic time as significant predictors.
Conclusions:
- The prevalence of coronary calcium is high in heart transplant recipients.
- Recipient dyslipoproteinemia, systemic hypertension, and donor organ ischemic time are key predictors.
- These factors are crucial for managing cardiovascular risk in this population.
Abstract:
Coronary calcium detected by ultrafast computed tomography (CT) has been shown to be a marker of coronary artery disease in heart transplant recipients. The objective of this study was to examine the possible determinants of coronary calcium after heart transplantation. Over a 15-month period, 102 consecutive cardiac transplant recipients (mean age 53 years, 88 men) underwent ultrafast CT scanning of the heart, in addition to coronary angiography, to determine coronary calcium score on their annual follow-up (a median of 4.6 years [range 63 days to 9.1 years] after transplant). The following data were also recorded: the recipient's sex and date of birth, date of transplantation, date of ultrafast computed tomography and coronary angiography; recipient pretransplant diagnosis, history of diabetes mellitus and systemic hypertension, fasting lipid profile, immunosuppression, number of rejection episodes, and donor organ ischemic time. Forty six patients (45.1%) had total calcium scores >0 and 41 (40.2%) had at least 1 major coronary with angiographic narrowing >24%. On univariate analysis, coronary calcium was significantly associated with dyslipoproteinemia, total cholesterol was >6.0 mmol/L (240 mg/dl), triglycerides were >3.0 mmol/L (265 mg/dl), and lipoprotein(a) >30 mg/ dl; > or =25% angiographic disease was significantly associated with coronary calcium and dyslipoproteinemia. Logistic regression revealed that dyslipoproteinemia, systemic hypertension, and donor ischemic time were significant predictors of coronary calcium in transplanted hearts. We conclude that the prevalence of coronary calcium in heart transplant recipients is high and is related to recipient dyslipoproteinemia, systemic hypertension, and donor organ ischemic time.