Evaluation of Cardiac Allograft Vasculopathy by Multidetector Computed Tomography and Whole-Heart Magnetic Resonance Coronary Angiography

Abstract

Background: Cardiac allograft vasculopathy (CAV) is a major complication that limits the long-term survival of recipients of heart transplants. In the present study the feasibility of 2 noninvasive approaches for detecting CAV (multidetector computed tomography (MDCT) and whole-heart magnetic resonance coronary angiography (MRCA)) was compared with conventional coronary angiography (CCAG). Methods and Results:Of 22 heart transplant recipients who underwent CCAG screening, 13 had only MDCT, 16 had only MRCA, and 7 had both noninvasive modalities. The coronary arterial tree was divided into 9 segments. Detection of vasculopathy by coronary segments was compared between 16-/64-detector computed tomography (CT) or MRCA and CCAG. The sensitivity of both 16- and 64-detector CT for diagnosing CAV was 69.6%, and specificity was 96.8%. The sensitivity and specificity by 64-detector CT alone were 90.0% and 97.5%, respectively; its positive and negative predictive values were 81.8% and 98.7% respectively. For MRCA, sensitivity was 60%, specificity, 100%, positive predictive value, 100% and negative predictive value, 92.2%. MRCA showed no false positives. Conclusions:MDCT, especially 64-detector CT, is feasible for detecting CAV, whereas MRCA currently shows limited sensitivity. (Circ J 2010; 74: 946 - 953)

Systolic prospectively ECG-triggered dual-source CT angiography for evaluation of the coronary arteries in heart transplant recipients

“…Recent reports underline the potential of MDCT to replace conventional coronary angiography for the diagnosis and follow-up of cardiac allograft vasculopathy in heart transplant recipients [5][6][7][8]10]. However, emerging data on exposure to ionising radiation from imaging procedures [27][28][29] and particularly the relatively high radiation dose related to cardiac CT [11,12,31], has raised concern among the medical community about keeping the radiation dose at minimum levels.…”

“…Among the different non-invasive imaging techniques routinely employed in the diagnostic work-up of cardiac allograft vasculopathy, i.e. nuclear perfusion tests [3] and stress echocardiography [4], multidetector computed tomography (CT) has emerged as a promising tool to reliably rule out this disease [5][6][7][8]. In particular, dual-source CT (DSCT) has been shown to provide diagnostic image quality in heart transplant recipients [9] while allowing significant coronary allograft vasculopathy to be reliably excluded [10].…”

Magnetic resonance assessment of left ventricular diastolic dysfunction for detecting cardiac allograft vasculopathy in recipients of heart transplants

“…Few studies have assessed the feasibility of whole-heart MR coronary angiography for detecting CAV. Previous study using CCA as a reference demonstrated limited sensitivity (60%) of this technique, much lower than that by CT coronary angiography using novel multi-detector CT scanners, presumably because of insufficient spatial and temporal resolution [38]. The latter three techniques are more complex and require longer time than PFR measurement for examination, image post-processing, and data analysis.…”

Cardiac Allograft Vasculopathy

“…91 The major drawbacks with the routine use of MDCT after HTx include the high heart rate of patients which might compromise imaging quality, contrast-induced nephropathy, and radiation. 94,95 Compared with IVUS, the sensitivity, specificity, positive and negative predictive values for the detection of CAV by dual source CT were 85%, 84%, 76%, and 91%, respectively. Dual source CT permits the investigation of HTx recipients concerning the presence of CAV with good image quality and high diagnostic accuracy.…”