Image Quality of Prospectively ECG-Triggered Coronary CT Angiography in Heart Transplant Recipients

Bartykowszki, Andrea; Kolossváry, Márton; Jermendy, Ádám L.; Karády, Júlia; Szilveszter, Bálint; Károlyi, Mihály; Balogh, Orsolya; Sax, Balázs; Merkely, Béla; Maurovich-Horvat, Pál

doi:10.2214/ajr.17.18546

Cited by 10 publications

(5 citation statements)

References 30 publications

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“…While in older scanners image quality depended strongly on the heart rate [29][30][31], recent studies have shown that contemporary CTA technology reaches diagnostic image quality [18,19,32,33]. Our study endorses these results by revealing good image quality at a mean heart rate of 74 bpm and median effective radiation dose of 5.8 mSv.…”

Section: Discussionsupporting

confidence: 84%

“…Coronary computed tomography angiography (CTA) represents a noninvasive alternative to ICA and IVUS [10][11][12] and has been successfully used in numerous large trials investigating coronary heart disease (CHD) [13][14][15][16] and in smaller studies of CAV [17][18][19]. Still, it remains unknown whether quantitative CTA measures are associated with CAV and how the diagnosis of CAV using these measures agrees with diagnosis made by ICA.…”

Section: Introductionmentioning

confidence: 99%

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Quantitative coronary computed tomography angiography for the detection of cardiac allograft vasculopathy

et al. 2020

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Objectives To associate coronary wall volume and composition, derived from coronary computed tomography angiography (CTA), with cardiac allograft vasculopathy (CAV) detected on invasive coronary angiography (ICA) in heart-transplanted (HTX) patients. Methods We included consecutive adults who received ICA and coronary CTA for evaluation of CAV ≥ 10 months after HTX. In all coronary segments, we assessed lumen and wall volumes and segmental length, calculated volume-length ratio (VLR) (volumes indexed by segmental length; mm 3 /mm), wall burden (WB) (wall/wall + lumen volumes; %), and assessed proportions of calcified, fibrotic, fibro-fatty, and low-attenuation tissue (%) in coronary wall. We rendered independent CTA measures associated with CAV by ICA, tested their discriminatory capacity, and assessed concordance between CTA and ICA. Results Among 50 patients (84% men; 53.6 ± 11.9 years), we analyzed 632 coronary segments. Mean interval between HTX and CTA was 6.7 ± 4.7 years and between ICA and CTA 1 (0-1) day. Segmental VLR, WB, and proportion of fibrotic tissue were independently associated with CAV (OR = 1.06-1.27; p ≤ 0.002), reaching a high discriminatory capacity (combination of all three: AUC = 0.84; 95%CI, 0.75-0.90). Concordance between CTA and ICA was higher in advanced CAV (88%) compared with that in none (37%) and mild (19%) CAV. Discordance was primarily driven by a large number of segments with coronary wall changes on CTA but without luminal stenoses on ICA (177/591; 25%). Conclusion CTA-derived coronary wall VLR, WB, and the proportion of fibrotic tissue are independent markers of CAV. Combination of these three parameters may aid the detection of early CAV not detected by ICA, the current standard of care. Key Points • Coronary CTA detects CAV in HTX patients.• Coronary wall volume-length ratio, wall burden, and proportion of fibrotic tissue are independently associated with CAV.• In contrast to ICA, coronary CTA may identify the early stages of CAV.

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Section: Discussionsupporting

confidence: 84%

Section: Introductionmentioning

confidence: 99%

Quantitative coronary computed tomography angiography for the detection of cardiac allograft vasculopathy

et al. 2020

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“…Yet, the clinical implementation of CCTA as a first-line image modality for the detection of CAV has been hampered due to lower image quality and higher radiation dose in patients with elevated heart rates [3]. Recent studies have shown that contemporary CT technology reaches good diagnostic image quality in HTx patients at reasonable radiation exposure [6,7,11,12]. In the present study with a large realworld HTx population with relatively high heart rates, similar results were observed.…”

Section: Feasibility Of Ccta For the Detection Of Cavsupporting

confidence: 84%

“…CCTA visualizes both the coronary lumen and wall with high sensitivity (86% to 89%) and specificity (89% to 99%), but has not yet been widely adopted due to concerns about potential lower image quality and higher radiation dose associated with the relatively high heart rates often encountered in HTx patients [5]. However, technical advances including increased detectorrow coverage, decreased rotation time, and iterative reconstruction algorithms have improved the image quality of CCTA in patients with elevated heart rates [6,7]. Therefore, CCTA has become a more attractive alternative to ICA for the detection of CAV with more ease for the patient and logistics at a lower cost and could be used as gatekeeper to ICA.…”

Section: Introductionmentioning

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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“…This is attributed to the denervation of the transplanted heart, which leads to an absence of heart-rate variation. Further studies have confirmed that a regular heart rate is associated with better image quality [48,49].…”

Section: The Role Of Coronary Computed Tomography Angiography and Nuc...mentioning

confidence: 86%

New Non-Invasive Imaging Technologies in Cardiac Transplant Follow-Up: Acquired Evidence and Future Options

Pergola,

Mattesi,

Cozza

et al. 2023

Diagnostics

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Heart transplantation (HT) is the established treatment for end-stage heart failure, significantly enhancing patients’ survival and quality of life. To ensure optimal outcomes, the routine monitoring of HT recipients is paramount. While existing guidelines offer guidance on a blend of invasive and non-invasive imaging techniques, certain aspects such as the timing of echocardiographic assessments and the role of echocardiography or cardiac magnetic resonance (CMR) as alternatives to serial endomyocardial biopsies (EMBs) for rejection monitoring are not specifically outlined in the guidelines. Furthermore, invasive coronary angiography (ICA) is still recommended as the gold-standard procedure, usually performed one year after surgery and every two years thereafter. This review focuses on recent advancements in non-invasive and contrast-saving imaging techniques that have been investigated for HT patients. The aim of the manuscript is to identify imaging modalities that may potentially replace or reduce the need for invasive procedures such as ICA and EMB, considering their respective advantages and disadvantages. We emphasize the transformative potential of non-invasive techniques in elevating patient care. Advanced echocardiography techniques, including strain imaging and tissue Doppler imaging, offer enhanced insights into cardiac function, while CMR, through its multi-parametric mapping techniques, such as T1 and T2 mapping, allows for the non-invasive assessment of inflammation and tissue characterization. Cardiac computed tomography (CCT), particularly with its ability to evaluate coronary artery disease and assess graft vasculopathy, emerges as an integral tool in the follow-up of HT patients. Recent studies have highlighted the potential of nuclear myocardial perfusion imaging, including myocardial blood flow quantification, as a non-invasive method for diagnosing and prognosticating CAV. These advanced imaging approaches hold promise in mitigating the need for invasive procedures like ICA and EMB when evaluating the benefits and limitations of each modality.

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Image Quality of Prospectively ECG-Triggered Coronary CT Angiography in Heart Transplant Recipients

Abstract: Prospectively ECG-triggered coronary CTA examinations of HTx recipients yielded diagnostic image quality with low radiation dose. Coronary CTA is a promising noninvasive alternative to routine catheterization during follow-up of HTx recipients to diagnose CAV.

Cited by 10 publications

References 30 publications

Quantitative coronary computed tomography angiography for the detection of cardiac allograft vasculopathy

Quantitative coronary computed tomography angiography for the detection of cardiac allograft vasculopathy

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

New Non-Invasive Imaging Technologies in Cardiac Transplant Follow-Up: Acquired Evidence and Future Options

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