View in EDS

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

Saved in:
Bibliographic Details
Title: Quantitative coronary computed tomography angiography for the detection of cardiac allograft vasculopathy
Authors: Borek Foldyna, Marcus Sandri, Christian Luecke, Jens Garbade, Robin Gohmann, Jochen Hahn, Julia Fischer, Matthias Gutberlet, Lukas Lehmkuhl
Source: Eur Radiol
Publisher Information: Springer Science and Business Media LLC, 2020.
Publication Year: 2020
Subject Terms: Adult, Male, Cardiac Catheterization, Computed Tomography Angiography, Coronary Artery Disease, Middle Aged, Vascular Remodeling, Allografts, Coronary Angiography, Coronary Vessels, Heart Transplantation [MeSH], Coronary Vessels/diagnostic imaging [MeSH], Female [MeSH], Cardiac, Computed tomography angiography, Aged [MeSH], Adult [MeSH], Allografts/diagnostic imaging [MeSH], Humans [MeSH], Computed Tomography Angiography/methods [MeSH], Middle Aged [MeSH], Tomography, X-Ray Computed/methods [MeSH], Invasive coronary angiography, Coronary Angiography/methods [MeSH], Heart transplantation, Cardiac allograft vasculopathy, Male [MeSH], Cardiac Catheterization [MeSH], Allografts/blood supply [MeSH], Postoperative Complications/diagnostic imaging [MeSH], Vascular Remodeling [MeSH], Coronary Artery Disease/diagnostic imaging [MeSH], Early Diagnosis [MeSH], 3. Good health, 03 medical and health sciences, Early Diagnosis, Postoperative Complications, 0302 clinical medicine, Heart Transplantation, Humans, Female, Tomography, X-Ray Computed, Aged
Description: 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; mm3/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.
Document Type: Article
Other literature type
Language: English
ISSN: 1432-1084
0938-7994
DOI: 10.1007/s00330-019-06653-3
Access URL: https://link.springer.com/content/pdf/10.1007/s00330-019-06653-3.pdf
https://pubmed.ncbi.nlm.nih.gov/32179995
https://link.springer.com/article/10.1007/s00330-019-06653-3
https://europepmc.org/article/MED/32179995
https://pubmed.ncbi.nlm.nih.gov/32179995/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7338811
https://repository.publisso.de/resource/frl:6469236
Rights: CC BY
Accession Number: edsair.doi.dedup.....d11bff6b65e2a71b2e722eea7594e027
Database: OpenAIRE
Description
Abstract: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; mm3/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.
ISSN:14321084
09387994
DOI:10.1007/s00330-019-06653-3