Clinical implementation of coronary computed tomography angiography for routine detection of cardiac allograft vasculopathy in heart transplant patients. (19th September 2021)

• Record Type: Journal Article
• Authors: Nous, Fay M. A.; Roest, Stefan; van Dijkman, Eva D.; Attrach, Mohamed; Caliskan, Kadir; Brugts, Jasper J.; Nieman, Koen; Hirsch, Alexander; Constantinescu, Alina A.; Manintveld, Olivier C.; Budde, Ricardo P.J.
• Is Part Of: Transplant international. Volume 34:Number 10(2021)
• Page Start: 1886
• Page End: 1894
• Publication Date: 2021-09-19
• Subjects: cardiac allograft vasculopathy -- computed tomography angiography -- coronary artery disease -- heart transplantation -- invasive coronary angiography; Transplantation of organs, tissues, etc -- Periodicals; 617.95405
• DOI: 10.1111/tri.13973
• Languages: English
• ISSNs: 0934-0874

Abstract

Summary: Cardiac allograft vasculopathy (CAV) is an accelerated form of coronary artery disease that affects long‐term outcomes in heart transplant (HTx) patients. We prospectively evaluated the feasibility of coronary computed tomography angiography (CCTA) for the detection of CAV during clinical implementation at our center. All consecutive HTx patients >4 years post‐transplant were actively converted from myocardial perfusion imaging to CCTA for the annual assessment of CAV. Between February 2018 and May 2019, 129/172 (75%) HTx patients underwent a CCTA. Renal impairment ( n = 21/43) was the most frequent reason for patients could not undergo CCTA. CCTA image quality was good–excellent in 118/129 (92%) patients, and the radiation dose was 2.1 (1.6–2.8) mSv. CCTA showed obstructive CAV in 19/129 (15%) patients. Thirteen (10%) patients underwent additional tests, of which 8 patients underwent coronary revascularization within 90 days of CCTA. After 1 year, 3 additional coronary angiograms were performed, resulting in one revascularization in a patient with known severe CAV who developed ventricular tachycardia. One myocardial infarction after coronary stenting and 2 non‐cardiac deaths were observed. CCTA can be successfully implemented for routine detection of CAV with good image quality and low radiation dose. CCTA allows CAV evaluation with the limited need for additional invasive testing. Abstract : CCTA can be safely and successfully implemented as a noninvasive alternative for routine detection of CAV in HTx patients with good image quality and low radiation dose.