Quantitative CT assessment identifies more heart transplanted patients with progressive coronary wall thickening than standard clinical read

Károlyi, Mihály; Kolossváry, Márton; Bartykowszki, Andrea; Kocsmár, Ildikó; Szilveszter, Bálint; Karády, Júlia; Merkely, Béla; Maurovich-Horvat, Pál

doi:10.1016/j.jcct.2018.11.006

Cited by 13 publications

(14 citation statements)

References 26 publications

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“…While in older scanners image quality depended strongly on the heart rate [29][30][31], recent studies have shown that contemporary CTA technology reaches diagnostic image quality [18,19,32,33]. Our study endorses these results by revealing good image quality at a mean heart rate of 74 bpm and median effective radiation dose of 5.8 mSv.…”

Section: Discussionsupporting

confidence: 84%

“…Nevertheless, there is only limited evidence about the utilization of quantitative CTA in HTX patients. For instance, Karolyi et al used serial CTA to show that quantitative assessment of coronary walls is feasible to measure coronary wall changes over time and that progression of coronary wall volume is driven by noncalcified components [19]. Our study underlines the feasibility and enhances these results by identifying coronary wall VLR, WB, and proportion of fibrotic tissue as independent indicators of CAV.…”

Section: Discussionmentioning

confidence: 52%

“…Left main, proximal right coronary artery, proximal left anterior descending, and proximal circumflex were considered proximal segments while the remaining as distal [21]. High reproducibility has been reported for this particular software package (wall burden intra-class correlation coefficient, 0.90 for intra-and 0.84 for inter-observer reliability [12,19]). (Supplemental Figure S1 shows the individual standard analytic steps as described elsewhere [11,12,19,22].…”

Section: Cta Acquisition and Coronary Vessel Segmentationmentioning

confidence: 99%

“…Coronary computed tomography angiography (CTA) represents a noninvasive alternative to ICA and IVUS [10][11][12] and has been successfully used in numerous large trials investigating coronary heart disease (CHD) [13][14][15][16] and in smaller studies of CAV [17][18][19]. Still, it remains unknown whether quantitative CTA measures are associated with CAV and how the diagnosis of CAV using these measures agrees with diagnosis made by ICA.…”

Section: Introductionmentioning

confidence: 99%

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Quantitative coronary computed tomography angiography for the detection of cardiac allograft vasculopathy

et al. 2020

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Objectives To associate coronary wall volume and composition, derived from coronary computed tomography angiography (CTA), with cardiac allograft vasculopathy (CAV) detected on invasive coronary angiography (ICA) in heart-transplanted (HTX) patients. Methods We included consecutive adults who received ICA and coronary CTA for evaluation of CAV ≥ 10 months after HTX. In all coronary segments, we assessed lumen and wall volumes and segmental length, calculated volume-length ratio (VLR) (volumes indexed by segmental length; mm 3 /mm), wall burden (WB) (wall/wall + lumen volumes; %), and assessed proportions of calcified, fibrotic, fibro-fatty, and low-attenuation tissue (%) in coronary wall. We rendered independent CTA measures associated with CAV by ICA, tested their discriminatory capacity, and assessed concordance between CTA and ICA. Results Among 50 patients (84% men; 53.6 ± 11.9 years), we analyzed 632 coronary segments. Mean interval between HTX and CTA was 6.7 ± 4.7 years and between ICA and CTA 1 (0-1) day. Segmental VLR, WB, and proportion of fibrotic tissue were independently associated with CAV (OR = 1.06-1.27; p ≤ 0.002), reaching a high discriminatory capacity (combination of all three: AUC = 0.84; 95%CI, 0.75-0.90). Concordance between CTA and ICA was higher in advanced CAV (88%) compared with that in none (37%) and mild (19%) CAV. Discordance was primarily driven by a large number of segments with coronary wall changes on CTA but without luminal stenoses on ICA (177/591; 25%). Conclusion CTA-derived coronary wall VLR, WB, and the proportion of fibrotic tissue are independent markers of CAV. Combination of these three parameters may aid the detection of early CAV not detected by ICA, the current standard of care. Key Points • Coronary CTA detects CAV in HTX patients.• Coronary wall volume-length ratio, wall burden, and proportion of fibrotic tissue are independently associated with CAV.• In contrast to ICA, coronary CTA may identify the early stages of CAV.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 52%

Section: Cta Acquisition and Coronary Vessel Segmentationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Quantitative coronary computed tomography angiography for the detection of cardiac allograft vasculopathy

et al. 2020

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“…Yet, the clinical implementation of CCTA as a first-line image modality for the detection of CAV has been hampered due to lower image quality and higher radiation dose in patients with elevated heart rates [3]. Recent studies have shown that contemporary CT technology reaches good diagnostic image quality in HTx patients at reasonable radiation exposure [6,7,11,12]. In the present study with a large realworld HTx population with relatively high heart rates, similar results were observed.…”

Section: Feasibility Of Ccta For the Detection Of Cavsupporting

confidence: 84%

Clinical implementation of coronary computed tomography angiography for routine detection of cardiac allograft vasculopathy in heart transplant patients

et al. 2021

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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 posttransplant 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.

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Evaluation of cardiac allograft vasculopathy by positron emission tomography

Fehér

Sinusas

2021

Journal of Nuclear Cardiology

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Quantitative CT assessment identifies more heart transplanted patients with progressive coronary wall thickening than standard clinical read

Cited by 13 publications

References 26 publications

Quantitative coronary computed tomography angiography for the detection of cardiac allograft vasculopathy

Quantitative coronary computed tomography angiography for the detection of cardiac allograft vasculopathy

Clinical implementation of coronary computed tomography angiography for routine detection of cardiac allograft vasculopathy in heart transplant patients

Evaluation of cardiac allograft vasculopathy by positron emission tomography

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