Detection of Transplant Coronary Artery Disease Using Multidetector Computed Tomography With Adaptative Multisegment Reconstruction

Sigurðsson, Garðar; Carrascosa, Patrícia; Yamani, Mohammad H.; Greenberg, Neil L.; Perrone, Sergio V.; Lev, Gustavo; Desai, Milind Y.; García, Mario J.

doi:10.1016/j.jacc.2006.04.082

Cited by 65 publications

(44 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In agreement with this, MDCT with adaptive multisegment reconstruction has a sensitivity and specificity of 86% and 99%, respectively. 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

View full text Add to dashboard Cite

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.)

show abstract

Section: Multidetector Ctmentioning

confidence: 99%

Cardiac Allograft Vasculopathy

2008

View full text Add to dashboard Cite

show abstract

“…The literature provides some data regarding the heart transplant population: Sigurdsson et al [93] used a 16-detector MDCT to identify coronary stenosis and compared to angiographic disease (defined by luminal stenosis > 95%). Sensitivity, specificity, positive and negative predictive values were 86%, 99%, 81% and 99% respectively, unfortunately only a few subgroup of patients underwent IVUS.…”

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

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|

show abstract

“…Among the different non-invasive imaging techniques routinely employed in the diagnostic work-up of cardiac allograft vasculopathy, i.e. nuclear perfusion tests [3] and stress echocardiography [4], multidetector computed tomography (CT) has emerged as a promising tool to reliably rule out this disease [5][6][7][8]. In particular, dual-source CT (DSCT) has been shown to provide diagnostic image quality in heart transplant recipients [9] while allowing significant coronary allograft vasculopathy to be reliably excluded [10].…”

Section: Introductionmentioning

confidence: 99%

Systolic prospectively ECG-triggered dual-source CT angiography for evaluation of the coronary arteries in heart transplant recipients

et al. 2011

View full text Add to dashboard Cite

show abstract

Detection of Transplant Coronary Artery Disease Using Multidetector Computed Tomography With Adaptative Multisegment Reconstruction

Abstract: Detection of occlusive coronary disease in heart transplant recipients with elevated resting heart rate by MDCT is feasible using multicycle reconstruction. The need for surveillance invasive coronary angiography in transplant recipients might be mitigated by use of MDCT.

Cited by 65 publications

References 27 publications

Cardiac Allograft Vasculopathy

Cardiac Allograft Vasculopathy

Diagnosis and management of coronary allograft vasculopathy in children and adolescents

Systolic prospectively ECG-triggered dual-source CT angiography for evaluation of the coronary arteries in heart transplant recipients

Contact Info

Product

Resources

About