Comprehensive morphologic and functional imaging of heart transplant patients: first experience with dynamic perfusion CT

Oebel, Sabrina; Hamada, Sandra; Higashigaito, Kai; Spiczak, Jochen von; Klotz, Ernst; Enseleit, Frank; Hinzpeter, Ricarda; Ruschitzka, Frank; Manka, Robert; Alkadhi, Hatem

doi:10.1007/s00330-018-5436-9

Cited by 7 publications

(3 citation statements)

References 41 publications

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“… 45) Stress perfusion CT may allow for the detection of perfusion change in LV myocardium of patients with CAV. 46) Finally, the coronary artery calcium (CAC) score seems to be of particular interest as recent prospective study including 113 transplant recipients cited an overall sensitivity of 88% and negative predictive value of 97% for CAC in detecting CAV 2–3 (moderate-severe CAV). 47) …”

Section: Discussionmentioning

confidence: 99%

Multiparametric Cardiac Magnetic Resonance Imaging Detects Altered Myocardial Tissue and Function in Heart Transplantation Recipients Monitored for Cardiac Allograft Vasculopathy

Abbasi

Blake

Sarnari

et al. 2022

J Cardiovasc Imaging

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BACKGROUND Cardiac allograft vasculopathy (CAV) is a complication beyond the first-year post-heart transplantation (HTx). We aimed to test the utility of cardiac magnetic resonance (CMR) to detect functional/structural changes in HTx recipients with CAV. METHODS Seventy-seven prospectively recruited HTx recipients beyond the first-year post-HTx and 18 healthy controls underwent CMR, including cine imaging of ventricular function and T1- and T2-mapping to assess myocardial tissue changes. Data analysis included quantification of global cardiac function and regional T2, T1 and extracellular volume based on the 16-segment model. International Society for Heart and Lung Transplantation criteria was used to adjudicate CAV grade (0–3) based on coronary angiography. RESULTS The majority of HTx recipients (73%) presented with CAV (1: n = 42, 2/3: n = 14, 0: n = 21). Global and segmental T2 (49.5 ± 3.4 ms vs 50.6 ± 3.4 ms, p < 0.001;16/16 segments) were significantly elevated in CAV-0 compared to controls. When comparing CAV-2/3 to CAV-1, global and segmental T2 were significantly increased (53.6 ± 3.2 ms vs. 50.6 ± 2.9 ms, p < 0.001; 16/16 segments) and left ventricular ejection fraction was significantly decreased (54 ± 9% vs. 59 ± 9%, p < 0.05). No global, structural, or functional differences were seen between CAV-0 and CAV-1. CONCLUSIONS Transplanted hearts display functional and structural alteration compared to native hearts, even in those without evidence of macrovasculopathy (CAV-0). In addition, CMR tissue parameters were sensitive to changes in CAV-1 vs. 2/3 (mild vs. moderate/severe). Further studies are warranted to evaluate the diagnostic value of CMR for the detection and classification of CAV.

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Section: Discussionmentioning

confidence: 99%

Multiparametric Cardiac Magnetic Resonance Imaging Detects Altered Myocardial Tissue and Function in Heart Transplantation Recipients Monitored for Cardiac Allograft Vasculopathy

Abbasi

Blake

Sarnari

et al. 2022

J Cardiovasc Imaging

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“…Therefore, MPI could be valuable in selected cases. Moreover, emerging CT technologies including CT-derived fractional flow reserve and CT MPI offer the potential to functionally assess the coronary arteries without using additional modalities [21,22]. Further investigations of these methods are needed to confirm this in HTx patients.…”

Section: Limitations Of Ccta For the Detection Of Cavmentioning

confidence: 99%

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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“…In a study by Oebel et al, a combined protocol of CCTA plus stress CTP was tested to unmask both anatomical and functional CAV-related consequences, and revealed a very high accuracy on a per-patient basis when compared to ICA and stress-CMR [138].…”

Section: Cardiac Ct and Heart Transplantationmentioning

confidence: 99%

The Incremental Role of Coronary Computed Tomography in Chronic Coronary Syndromes

Baessato

Guglielmo

Muscogiuri

et al. 2020

JCM

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In the context of chronic coronary syndromes (CCS), coronary computed tomography angiography (CCTA) has gained broad acceptance as a noninvasive anatomical imaging tool with ability of excluding coronary stenosis with strong negative predictive value. Atherosclerotic plaque lesions are independent predictors of cardiovascular outcomes in high risk patients with known coronary artery disease (CAD). Calcium detection is commonly expressed through the coronary artery calcium score (CACS), but further research is warranted to confirm the powerness of a CACS-only strategy in both diagnosis and prognosis assessment. Recent studies evidence how defined plaque composition characteristics effectively relate to the risk of plaque instabilization and the overall ischemic burden. Fractional flow reserve from CCTA (FFR-CT) has been demonstrated as a reliable method for noninvasive functional evaluation of coronary lesions severity, while the assessment of perfusion imaging under stress conditions is growing as a useful tool for assessment of myocardial ischemia. Moreover, specific applications in procedural planning of transcatheter valve substitution and follow-up of heart transplantation have gained recent importance. This review illustrates the incremental role of CCTA, which can potentially revolutionize the diagnosis and management pathway within the wide clinical spectrum of CCS.

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Comprehensive morphologic and functional imaging of heart transplant patients: first experience with dynamic perfusion CT

Cited by 7 publications

References 41 publications

Multiparametric Cardiac Magnetic Resonance Imaging Detects Altered Myocardial Tissue and Function in Heart Transplantation Recipients Monitored for Cardiac Allograft Vasculopathy

Multiparametric Cardiac Magnetic Resonance Imaging Detects Altered Myocardial Tissue and Function in Heart Transplantation Recipients Monitored for Cardiac Allograft Vasculopathy

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

The Incremental Role of Coronary Computed Tomography in Chronic Coronary Syndromes

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