Coronary Computed Tomography Angiography for the Detection of Cardiac Allograft Vasculopathy

Abstract

CCTA using currently available technology is a reliable noninvasive imaging alternative to coronary angiography with an excellent sensitivity, specificity, and NPV for the detection of CAV.

Imaging in patients with advanced therapies for heart failure

“…5 Allograft vasculopathy is diffuse, involving large epicardial and smaller intramyocardial arteries, and its course is unpredictable, and often clinically silent due to denervation. 6 Approximately 10% of patients die in the 12 months following a diagnosis of cardiac allograft vasculopathy. 1 Yet, there are available therapies such as pharmacologic inhibition/modulation of cellular proliferative signaling, which have been associated with reduced incidence and slower progression 6 ; thus the need for early and accurate detection is paramount.…”

“…6 Approximately 10% of patients die in the 12 months following a diagnosis of cardiac allograft vasculopathy. 1 Yet, there are available therapies such as pharmacologic inhibition/modulation of cellular proliferative signaling, which have been associated with reduced incidence and slower progression 6 ; thus the need for early and accurate detection is paramount. Invasive catheter-based conventional coronary angiography has long been the See related article, pp.…”

“…Adding intravascular ultrasound (IVUS) to invasive coronary angiography improves its detection rate considerably by providing additional information about maximal intimal wall thickness, of which an increase of at least 0.5 mm within the first year posttransplant has been associated with poor cardiovascular outcomes. 6,7 Optical coherence tomography (OCT), a newer invasive catheter-based imaging modality, not only appears to correlate well with IVUS with regard to intimal wall thickness measurements, but can also provide better plaque characterization due to its higher image resolution. 8 Beyond these catheter-based techniques, new noninvasive modalities offer the potential to accomplish this diagnosis in the earliest phases.…”

“…In a meta-analysis covered in Gupta et al's article, 3 coronary CT angiography offered excellent specificity and negative predictive value for the detection of vasculopathy compared to invasive coronary angiography as the gold standard. 6 In addition to a robust appraisal of coronary CT angiography, Gupta et al's article provides a thorough and broad review of myocardial perfusion imaging with established perfusion techniques of SPECT and contrast-enhanced dobutamine stress echocardiography. CMR has intrinsic advantages for cardiovascular imaging and functional measurements, since it offers a means of quantifying absolute myocardial perfusion and vascular flow, in addition to being the most accurate and comprehensive tool for assessment of cardiac volumes and anatomy.…”

Transplant coronary heart disease: challenges and solutions

“…45 CCTA has a sensitivity of up to 89% and an excellent negative predictive value of 97% for CAV. 46 In a recent meta-analysis, the newest-generation CCTA ($$16 slices) was compared to coronary angiography and IVUS and the analysis showed that CCTA was accurate in excluding CAV in the majority of OHT patients, especially when compared to standard coronary angiography. When compared to IVUS, the sensitivity and negative predictive value of CCTA was lower (81% and 50%, respectively), likely because CT is designed to assess the lumen size and not intimal hyperplasia.…”