Coronary computed tomography–angiography quantitative plaque analysis improves detection of early cardiac allograft vasculopathy: A pilot study

Abstract

Cardiac allograft vasculopathy (CAV) is an increasingly important complication after cardiac transplant. We assessed the additive diagnostic benefit of quantitative plaque analysis in patients undergoing coronary computed tomography-angiography (CCTA). Consecutive patients undergoing CCTA for CAV surveillance were identified. Scans were visually interpreted for coronary stenosis. Semiautomated software was used to quantify noncalcified plaque (NCP), as well as its components. Optimal diagnostic cut-offs for CAV, with coronary angiography as gold standard, were defined using receiver operating characteristic curves. In total, 36 scans were identified in 17 patients. CAV was present in 17 (46.0%) reference coronary angiograms, at a median of 1.9 years before CCTA. Median NCP (147 vs 58, P < .001), low-density NCP (median 4.5 vs 0.9, P = .003), fibrous plaque (median 76.1 vs 31.1, P = .003), and fibrofatty plaque (median 63.6 vs 27.6, P < .001) volumes were higher in patients with CAV, whereas calcified plaque was not (median 0.0 vs 0.0, P = .510). Visual assessment of CCTA alone was 70.6% sensitive and 100% specific for CAV. The addition of total NCP volume increased sensitivity to 82.4% while maintaining 100% specificity.NCP volume is significantly higher in patients with CAV. The addition of quantitative analysis to visual interpretation improves the sensitivity for detecting CAV without reducing specificity. K E Y W O R D S cardiovascular disease, clinical research/practice, coronary artery disease, diagnostic techniques and imaging: computed tomography, heart transplantation/cardiology, translational research/science, vasculopathy

BK Polyomavirus Nephropathy in Kidney Transplantation: Balancing Rejection and Infection

“…A recent study showed significant increasing BKPyV genotype-specific neutralizing antibody titers in KTRs [182]. A retrospective study showed prophylactic IVIG in the early post-transplant phase was associated with a significantly lower incidence of both BKPyV viremia and BKVN in high-risk recipients [183]. Further randomized control trials are in expectancy in this field for more substantial evidence of IVIG efficacy.…”

Clinicopathological correlations in heart transplantation recipients complicated by death or re-transplantation

“…In addition, several biomarkers in blood and tissue are found to correlate with the presence of CAV, and that may be able to predict CAV ( 53 , 54 , 59 ). Recent evidence suggests that novel imaging techniques have high sensitivity and specificity for detection of CAV, such as intravascular ultrasound (IVUS), optical coherence tomography (OCT) and coronary computed tomography angiography (CCTA) ( 55 – 58 ), but these are not yet routinely used. Efforts are ongoing to identify changes in EMB that can be predictive of the development of CAV, but further studies are needed ( 54 ).…”

The Incremental Role of Coronary Computed Tomography in Chronic Coronary Syndromes

“…Since CAV is mostly a progressive disease without overt coronary stenosis in the early stages, a combination of CCTA with direct plaque quantification methods may add further diagnostic accuracy in CAV surveillance. A recent study by Miller et al involving quantification of noncalcified plaque volume demonstrated a higher sensitivity and specificity by this combined approach and suggested performance of advanced plaque analysis in all studies where qualitative view has not evidenced relevant plaques [137].…”