Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Oct;34(10):1886-1894.
doi: 10.1111/tri.13973. Epub 2021 Sep 19.

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

Fay M A Nous  1   2 , Stefan Roest  2   3 , Eva D van Dijkman  1   2 , Mohamed Attrach  1 , Kadir Caliskan  2   3 , Jasper J Brugts  2   3 , Koen Nieman  1   2   4 , Alexander Hirsch  1   2 , Alina A Constantinescu  2   3 , Olivier C Manintveld  2   3 , Ricardo P J Budde  1   2
Affiliations

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

Fay M A Nous et al. Transpl Int. 2021 Oct.

Abstract

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.

Keywords: cardiac allograft vasculopathy; computed tomography angiography; coronary artery disease; heart transplantation; invasive coronary angiography.

PubMed Disclaimer

Conflict of interest statement

Dr. Budde reports institutional research support to the Erasmus MC from Siemens Healthineers outside he submitted work. Dr. Nieman reports unrestricted institutional grants from Siemens Healthineers, Bayer, and HeartFlow Inc., outside the submitted work. All other authors have not to disclose.

Figures

Figure 1
Figure 1
Flowchart of all HTx patients scheduled for annual routine follow‐up. CCTA: coronary computed tomography angiography; HTx: heart transplantation; MPI: myocardial perfusion imaging.
Figure 2
Figure 2
A case example of severe CAV in a 63‐year‐old man 29 years after HTx. The right coronary artery showed intermediate stenoses in the proximal and distal segments on ICA (a) and CCTA (b). The left anterior descending artery showed an intermediate stenosis in the middle segment on ICA (c) and CCTA (d). The circumflex artery showed severe stenosis in the distal segment on ICA (e) and CCTA (f). CAV: cardiac allograft vasculopathy; CCTA: coronary computed tomography angiography; HTx: heart transplantation; ICA: invasive coronary angiography.
Figure 3
Figure 3
Medical management after 90 days of follow‐up. CAV: cardiac allograft vasculopathy; CCTA: coronary computed tomography angiography; ICA: invasive coronary angiography; MPI: myocardial perfusion imaging. *Directly related to CCTA findings.
See this image and copyright information in PMC

References

    1. Lund LH, Edwards LB, Kucheryavaya AY, et al. The registry of the international society for heart and lung transplantation: Thirty‐second official adult heart transplantation report–2015; focus theme: early graft failure. J Heart Lung Transplant 2015; 34: 1244. - PubMed
    1. Mehra MR, Crespo‐Leiro MG, Dipchand A, et al. International Society for Heart and Lung Transplantation working formulation of a standardized nomenclature for cardiac allograft vasculopathy‐2010. J Heart Lung Transplant 2010; 29: 717. - PubMed
    1. Costanzo MR, Dipchand A, Starling R, et al. The international society of heart and lung transplantation guidelines for the care of heart transplant recipients. J Heart Lung Transplant 2010; 29: 914. - PubMed
    1. Tavakol M, Ashraf S, Brener SJ. Risks and complications of coronary angiography: a comprehensive review. Glob J Health Sci 2012; 4: 65. - PMC - PubMed
    1. Wever‐Pinzon O, Romero J, Kelesidis I, et al. Coronary computed tomography angiography for the detection of cardiac allograft vasculopathy: a meta‐analysis of prospective trials. J Am Coll Cardiol 2014; 63: 1992. - PubMed

MeSH terms