Comparison of Sixty-Four–Slice Multidetector Computed Tomographic Coronary Angiography to Coronary Angiography With Intravascular Ultrasound for the Detection of Transplant Vasculopathy

Gregory, Shawn A.; Ferencik, Maros; Achenbach, Stephan; Yeh, Robert W.; Hoffmann, Udo; Inglessis, Ignacio; Cury, Ricardo C.; Nieman, Koen; McNulty, Iris; Laffan, Josephine A.; Pomerantsev, Eugene; Brady, Thomas J.; Semigran, Marc J.; Jang, Ik Kyung

doi:10.1016/j.amjcard.2006.04.027

Cited by 88 publications

(61 citation statements)

References 28 publications

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“…70 In addition, 64-slice MDCT provides good to excellent image quality and has moderate to excellent test characteristics for the detection of CAV. 41 Iyengar et al 71 found a good overall agreement of conventional catheter-based angiography and 64-slice MDCT, with MDCT eventually being superior to identify nonobstructive vessel wall disease.…”

Section: Multidetector Ctmentioning

confidence: 99%

Cardiac Allograft Vasculopathy

2008

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Abstract-Cardiac allograft vasculopathy (CAV) continues to limit the long-term success of cardiac transplantation.Recent insights have underscored the fact that innate and adaptive immune responses are involved in the pathogenesis of CAV. Vascular lesions are the result of cumulative endothelial injuries induced both by alloimmune responses and by nonspecific insults (including ischemia-reperfusion injury, viral infections, and metabolic disorders) in the context of impaired repair mechanisms. Intravascular ultrasound is the most sensitive method for detection of CAV, and progressive intimal thickening in the first posttransplant year identifies patients at high risk for future cardiovascular events. Encouraging results with regard to the detection of CAV by noninvasive methods should be an incentive to apply routine noninvasive imaging during mid-to long-term follow-up. Improved immunosuppressive drugs, including mycophenolate mofetil and proliferation signal inhibitors, as well as statins (in part via immunomodulation), have beneficial effects on CAV progression, although there is still a need to confirm the impact of vasodilators in improving outcome after heart transplantation. Coronary revascularization for CAV is only palliative, with no long-term survival benefit. Three main strategies for CAV prevention are currently under investigation: inhibition of growth factors and cytokines, cell therapy, and tolerance induction. However, because individual responses to an allograft change over time, assays to monitor the recipient's immune response and individualized methods for therapeutic immune modulation are clearly needed. (Circulation. 2008;117:2131-2141.)

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Section: Multidetector Ctmentioning

confidence: 99%

Cardiac Allograft Vasculopathy

2008

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“…9 A substantial number of heart transplant recipients have impaired renal function, mainly because of post-transplant administration of calcineurin-inhibitors, and are therefore at risk for contrast-induced nephropathy. 9 In addition, because of the smaller helical pitch and higher tube power, effective doses with 64-detector CT using retrospective ECG-gated helical technique (9.5-21.4 mSv) are higher than with 16-detector CT (3.1-9.4 mSv), as well as that required for recent routine diagnostic CCAG (≈2-10 mSv). 28, 29 The use of ECG-controlled tube current modulation reduces the effective dose by approximately 40%, as well as the lifetime attributable cancer risk, compared with the standard retrospective ECGgated helical technique, especially for women and younger patients, maintains diagnostic image quality, and is recommended to use whenever possible.…”

Section: Cardiac Allograft Vasculopathy By Mdct and Mrcamentioning

confidence: 99%

“…5, [8][9][10][11] Over the past decade, magnetic resonance coronary angiography (MRCA) has also evolved as a potential alternative to CCAG among patients with suspected anomalous CAD and coronary artery aneurysms. MRCA has 2 main advantages: neither radiation exposure nor administration of nephrotoxic contrast medium is required.…”

Section: Cardiac Allograft Vasculopathy By Mdct and Mrcamentioning

confidence: 99%

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

Nunoda

Machida

Sekikawa

et al. 2010

Circ J

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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)

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“…Sixty-four-channel coronary CTA has been tested in 2 small single-center studies (20 patients each), as a possible replacement for "routine" annual coronary catheterization with or without IVUS. 84,85 Although getting the transplanted heart to the target heart rate can be difficult, the study from the Massachusetts General Hospital obtained diagnostic quality images in 83% of coronary segments. Sensitivity for identifying coronary stenosis or coronary plaque judged by invasive coronary angiography plus IVUS was 70% with a specificity of 92%.…”

Section: Use Of Coronary Ct Angiography In the Follow-up Of Cardiac Tmentioning

confidence: 99%

ACCF/ACR/AHA/NASCI/SAIP/SCAI/SCCT 2010 Expert Consensus Document on Coronary Computed Tomographic Angiography

et al. 2010

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Comparison of Sixty-Four–Slice Multidetector Computed Tomographic Coronary Angiography to Coronary Angiography With Intravascular Ultrasound for the Detection of Transplant Vasculopathy

Cited by 88 publications

References 28 publications

Cardiac Allograft Vasculopathy

Cardiac Allograft Vasculopathy

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

ACCF/ACR/AHA/NASCI/SAIP/SCAI/SCCT 2010 Expert Consensus Document on Coronary Computed Tomographic Angiography

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