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)

Cardiac allograft vasculopathy (CAV) is a major late complication in heart transplant recipients, graded based on intravascular ultrasound (IVUS), and accelerates left ventricular (LV) diastolic dysfunction. We investigated the clinical feasibility of using magnetic resonance (MR) to assess LV diastolic dysfunction noninvasively in transplant recipients. Thirty-eight asymptomatic recipients (25 men, 37.2 ± 14.9 years) underwent both IVUS and cardiac MR. Based on IVUS, we divided the individuals into 2 groups using Stanford classification to categorize CAV development as either nonsignificant or advanced. We measured LV peak filling rate (PFR) and systolic function parameters, including LV ejection fraction (EF), stroke volume (SV), and cardiac output (CO) using cine MR; compared those values between groups; calculated receiver operating characteristic curve in the relationship between PFR value and CAV; and assessed myocardial late gadolinium enhancement (LGE) on contrast-enhanced MR. We classified CAV as advanced in 20 patients (53%) and nonsignificant in 18 (47%). LV EF, SV, and CO values were not significantly different. PFR was significantly lower in the advanced (3.63 ± 0.90 EDV/s) than nonsignificant group (4.43 ± 0.84 EDV/s, P = 0.01). The area under the curve was 0.76. We observed no myocardial LGE. MR measurement of PFR may permit noninvasive assessment of diastolic dysfunction associated with CAV before LV systolic dysfunction and myocardial infarction or scar formation develop.

Concomitant administration of calcium channel blockers (CCBs) and angiotensin-converting enzyme inhibitors (ACEIs) to hypertensive patients at high risk for cardiovascular disease can prevent cardiovascular disease occurrence, but the effects of this treatment on renal and vascular function in low-risk hypertensive patients are unknown. The current study was an open-label prospective study. Hypertensive patients with no history of cardiovascular disease who had not met their blood pressure (BP) goals with CCB treatment were administered perindopril and followed for 6 months. Both home and office BP were significantly lowered by perindopril administration. The morning/evening (M/E) ratios calculated from home BP were 1.31 and 1.05 for systolic blood pressure (SBP) and diastolic blood pressure (DBP), respectively. When the patients were divided into two groups based on the presence or absence of an anti-hypertensive response, urinary albumin excretion, and cardio ankle vascular index were significantly reduced by perindopril administration in all the subjects, irrespective of the presence or absence of anti-hypertensive reaction. In low-risk hypertensive patients, perindopril improves renal and vascular function probably via its persistent anti-hypertensive effects and the concomitant effects of CCB.

Heart transplant recipients undergo annual screening of early-stage cardiac allograft vasculopathy (CAV) by invasive coronary flow reserve (CFR) measurement. We compared the sensitivity for CAV detection between the CFR measurement and noninvasive magnetic resonance (MR) assessment of left ventricular (LV) diastolic function. In 46 asymptomatic recipients (29 men, aged 35.2 ± 16.1 years) 7.9 ± 4.3 years after transplantation, we measured LV peak filling rate (PFR) using cine MR and CFR in the left anterior descending artery by Doppler guidewire; classified recipients of class 0-2 as negative for CAV and class 3-4, positive, according to Stanford classification assessed by IVUS; compared those values between the 2 groups; and calculated receiver operating characteristic curve in the relationship between PFR value and CAV. We classified 20 recipients (43%) positive and 26 (57%) negative for CAV. Although there was no significant difference in CFR value, the PFR value was significantly lower in the positive (3.54 ± 0.84 EDV/s) than in negative group (4.39 ± 0.85 EDV/s, P = 0.002). Area under the curve was 0.78, and the sensitivity was 78% and specificity, 61%, when PFR cut-off value was 4.20. MR PFR measurement provides noninvasive prediction of CAV, preceding impaired CFR in asymptomatic recipients.

No abstract