46 Computed tomography coronary angiography use for cardiac allograft vasculopathy surveillance: 10 years of experience. (6th October 2022)

• Record Type: Journal Article
• Authors: O'Sullivan, C; Tanner, R; Buckley, J; Murphy, D; Lawlor, L; Mahon, N; O'Neill, J
• Is Part Of: Heart. Volume 108(2022)Supplement 3
• Page Start: A39
• Page End: A39
• Publication Date: 2022-10-06
• Subjects: Heart -- Diseases -- Treatment -- Periodicals; Cardiology -- Periodicals; 616.12
• DOI: 10.1136/heartjnl-2022-ICS.46
• Languages: English
• ISSNs: 1355-6037

Abstract

Abstract : Introduction: Cardiac allograft vasculopathy (CAV) is a significant factor limiting survival beyond one year in heart transplant recipients. Invasive coronary angiography (ICA) has traditionally acted as the gold standard for detecting CAV with computed tomography coronary angiography (CTCA) only being used in a limited number of transplant centres. Hence, we sought to describe our experience with CTCA for detecting CAV over a 10-year period. Methods: 206 orthotropic heart transplant (OHTx) recipients between 1985 – 2015 were retrospectively screened for inclusion. Patients were excluded if the CTCA was performed within 5 years of OHTx, and data on CTCA pre-medication and radiation dose were recorded when available. CTCA scans were conducted in the period 2011 – 2021. Patients who underwent an ICA after CTCA had the results of both tests correlated according to the International Society for Heart and Lung Transplantation (ISHLT) CAV grading system. CAV on CCTA was defined as, insignificant (<1%), mild (1–49%), moderate (50–70%) and severe (>70%); approximate to the ISHLT CAV ICA grading system stages 0–4. Results: 68 CTCAs were performed on 45 OHTx recipients (median age 54 [IQR 44–63], 27% female) during the study period. Mean time from transplant to first CTCA 12.5 ± 5.2 years (range 5–26 years). Patient characteristics are summarised below ( table 1 ). Oral metoprolol (mean dose 60 ±31mg) was used in 22 of the 23 cases (95%) where pre-medication data were available. Ivabradine 5mg was used before two CTCAs. No symptomatic bradycardia was reported in response to pre-medication. The mean radiation dose (Dose Length Product) per CTCA was 500 ±253 mGy.cm Of the 68 CTCAs performed, 42 (62%) CT scans had insignificant coronary obstructions. Mild, moderate and severe CAV was reported in 19 (28%), 3 (4%) and 4 (6%) CTCAs respectively. Of the patients with severe CAV on CTCA the mean Agatson coronary calcium score was 122 (range 0–528) suggesting it to be a poor metric to detect CAV. In total, 17 (25%) patients had an ICA performed after their CTCA, during the study period. The majority (n=15, 88%) of CTCA CAV grading correlated with the same disease severity noted on ICA. One patient was downgraded from moderate to mild CAV on ICA and one patient with reported moderate CAV on CTCA had significant branch vessel (<2mm) CAV on subsequent ICA. There were no serious adverse events related to CTCA. Conclusion: CTCA is safe and reliable alternative to traditional ICA for detecting CAV. Furthermore, CTCA facilitated a reduction in the reliance on ICA in this study cohort. The non-invasive nature and lower cost of CTCA further support the wider application of CTCA in screening for CAV.