Detection of Coronary Artery Disease in Orthotopic Heart Transplant Recipients With 64-Detector Row Computed Tomography Angiography

Iyengar, Srinivas; Feldman, David S.; Cooke, Glen E.; Leier, Carl V.; Raman, Subha V.

doi:10.1016/j.healun.2006.06.018

Cited by 45 publications

(25 citation statements)

References 7 publications

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“…However, in this study, slightly less than 20% of coronary segments (mainly distal) could not been analysed due to poor image quality (probably in relation with elevated heart rate) [18] . Recent studies showed that dual source MDCT allows good image quality of vessel lumen [94,95] and, when validated against IVUS, high diagnostic accuracy [96] . A small study, just under 20 patients, demonstrated that MDCT, using 64-slices, was superior to angiography for the identification of non-obstructive vessel wall disease.…”

Section: Multidetector Computed Tomographymentioning

confidence: 99%

“…A small study, just under 20 patients, demonstrated that MDCT, using 64-slices, was superior to angiography for the identification of non-obstructive vessel wall disease. However, they did not use IVUS for comparison [94] . Schepis et al [96] compared 64 channels dual source MDCT with IVUS to look at vessel wall thickness.…”

Section: Multidetector Computed Tomographymentioning

confidence: 99%

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Diagnosis and management of coronary allograft vasculopathy in children and adolescents

Dedieu

Greil

Wong

et al. 2014

WJT

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Coronary allograft vasculopathy remains one of the leading causes of death beyond the first year post transplant. As a result of denervation following transplantation, patients lack ischaemic symptoms and presentation is often late when the graft is already compromised. Current diagnostic tools are rather invasive, or in case of angiography, significantly lack sensitivity. Therefore a non-invasive tool that could allow early diagnosis would be invaluable.This paper review the disease form its different diagnosis techniques,including new and less invasive diagnostic tools to its pharmacological management and possible treatments. DEFINITION AND PHYSIOPATHOLOGYIn children, coronary allograft vasculopathy (CAV) remains the main limiting survival factor after heart transplantation and the major cause of mortality after the first year post transplant leading ultimately to graft loss [1,2] . One elegant etiological description of CAV is that of "immunologic mechanisms operating in a milieu of nonimmunologic risk factors" [3] . The process is believed to start off as a response to endothelial injury in the graft, originated by a complex interaction of multiple donor and recipient factors. The resulting endothelial dysfunction, leads to altered endothelial permeability and subsequent intimal hyperplasia as a consequence of the vascular remodeling originated by the inflammatory response. The immunologic events constitute the original trigger and noninflammatory events such as cytomegalovirus infection, ischemic time (reperfusion injury), increased donor age and classical cardiovascular risk factors (i.e., diabetes, dyslipidemias, smoking and hypertension), perpetuate the inflammatory response and increase the endothelial injury [4] . Typical lesions (Figures 1 and 2) consist of diffuse intimal proliferation leading to the development of luminal stenosis and small vessels occlusion which then limits blood supply to the graft causing chronic vascular injury and ultimately myocardial ischemia [5] . The lesions develop earlier and quicker than atherosclerotic lesions. REVIEW 276December 24, 2014|Volume 4|Issue 4|

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Section: Multidetector Computed Tomographymentioning

confidence: 99%

Section: Multidetector Computed Tomographymentioning

confidence: 99%

Diagnosis and management of coronary allograft vasculopathy in children and adolescents

Dedieu

Greil

Wong

et al. 2014

WJT

View full text Add to dashboard Cite

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“…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%

“…7 IVUS is also an invasive procedure, as with CCAG, and because of serious risks associated with intravascular catheter manipulation, it is not frequently performed. 8 …”

Section: Cav and Invasive Screening Testsmentioning

confidence: 99%

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

Mark

Berman²,

Budoff³

et al. 2010

Cathet Cardio Intervent

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Detection of Coronary Artery Disease in Orthotopic Heart Transplant Recipients With 64-Detector Row Computed Tomography Angiography

Cited by 45 publications

References 7 publications

Diagnosis and management of coronary allograft vasculopathy in children and adolescents

Diagnosis and management of coronary allograft vasculopathy in children and adolescents

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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