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. 2025 Dec 13.
doi: 10.1007/s00330-025-12200-0. Online ahead of print.

Temporal changes in coronary artery calcium in heart transplantation patients

Simran P Sharma #  1   2 , Britt C J van Dijk #  1   2   3 , Daniel Bos  2   4 , Alexander Hirsch  1   2 , Fay M A Nous  1   2 , Yannick J H J Taverne  3   5 , Henk S Schipper  3   6 , Rudolf A de Boer  1 , Olivier C Manintveld  7   8 , Ricardo P J Budde  1   2
Affiliations

Temporal changes in coronary artery calcium in heart transplantation patients

Simran P Sharma et al. Eur Radiol. .

Abstract

Objectives: Coronary artery calcium (CAC) scoring is a well-established marker of atherosclerotic burden in the general population. Limited research has examined CAC progression and clinical implications in heart transplant (HT) recipients. We evaluated CAC progression in HT patients during long-term follow-up.

Materials and methods: We included adult HT recipients (≥ 5 years post-HT) from a retrospective single-center cohort undergoing annual cardiac CT with ≥ 4 years of follow-up. CAC scores were assessed using non-contrast CT. Patients were classified into two groups: no CAC progression (CAC = 0 across all CT scans) or any increase in CAC during follow-up. Generalized linear mixed models evaluated temporal changes in CAC; logistic regression identified variables associated with CAC progression.

Results: Among 116 patients (median age at baseline CT: 52 [38-63] years, 62% male), 65 showed CAC progression. From baseline to final CT, the proportion of patients with cardiac allograft vasculopathy (CAV) score 0 declined (90-83%), while CAV 1 and 3 increased (3-6%; 8-11%). CAC scores showed an annual increase in Ln(CAC + 1) of 0.4 (95% CI: 0.4-0.5; p < 0.001), corresponding to a 55% relative yearly increase. Significant interactions were found with recipient age at baseline CT (p = 0.008), donor heart age (p < 0.001), sex (p = 0.024), and recipient ischemic cardiomyopathy (p < 0.001). Only donor heart age was independently associated with CAC progression (p < 0.001).

Conclusion: CAC progression is common post-HT, with donor heart age showing the strongest association. Younger recipient and donor heart age, male sex, and ischemic cardiomyopathy were associated with faster CAC progression, suggesting the need for closer surveillance and more aggressive cardiovascular management.

Key points: Question Longitudinal changes in CAC score were assessed in HT recipients to provide insights into cardiovascular risk and disease progression. Findings Over half of HT recipients showed CAC progression, which was significantly associated with donor age. Recipient age, sex, and primary diagnosis influenced progression rate. Clinical relevance Routine CAC monitoring may help identify patients at higher risk of cardiovascular events after heart transplantation, allowing for closer surveillance and more aggressive cardiovascular management, which in turn might improve long-term outcomes.

Keywords: Coronary artery disease; Coronary vessels; Heart transplantation; Tomography (X-ray computed).

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Conflict of interest statement

Compliance with ethical standards. Guarantor: The scientific guarantor of this publication is O.C. Manintveld. Conflict of interest: S.P. Sharma received institutional support from Erasmus MC from Siemens Healthineers. B.C.J. van Dijk has no conflict of interest. D. Bos has no conflict of interest. A. Hirsch received a research grant from GE Healthcare and consultancy/speaker fees from GE Healthcare, Bayer, and Bristol Myers Squibb. He is an advisory board member of Medis Medical Imaging Systems and was the MRI corelab supervisor of Cardialysis BV until 2022. F.M.A. Nous has no conflict of interest. Yannick J.H.J. Taverne has no conflict of interest. H.S. was supported by an Erasmus MC fellowship. The institution of Dr. De Boer has received research grants and/or fees from Alnylam, AstraZeneca, Abbott, Bristol-Myers Squibb, NovoNordisk, and Roche; Dr. de Boer has had speaker engagements with and/or received fees from and/or served on an advisory board for Abbott, AstraZeneca, Bristol Myers Squibb, NovoNordisk, Roche, and Zoll; Dr. de Boer received travel support from Abbott and NovoNordisk. O. Manintveld received a lecture fee and travel reimbursement from Siemens Healthineers, paid directly to Erasmus MC. R. Budde received institutional support to Erasmus MC from Siemens Healthineers; lecture fee and travel reimbursement from Siemens Healthineers paid directly to Erasmus MC; lecture fee from Bayer; board member of the European Society of Cardiovascular Radiology and the Cardiovascular section of the Dutch Society of Radiology; editorial board member of Radiology: Cardiothoracic Imaging, European Heart Journal—Digital Health, and the European Journal of Hybrid Imaging; grant from HeartFlow to Erasmus MC. The Erasmus MC received institutional support from Siemens Healthineers and HeartFlow. Statistics and biometry: No complex statistical methods were necessary for this paper. Informed consent: Only if the study is on human subjects: written informed consent was obtained from all subjects (patients) in this study. Ethical approval: Institutional Review Board approval was obtained. Study subjects or cohorts overlap: Some study subjects or cohorts have been previously reported in Nous FMA et al [22]. Methodology: Retrospective Observational Performed at one institution

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