Comparison of dual source computed tomography versus intravascular ultrasound for evaluation of coronary arteries at least one year after cardiac transplantation

OBJECTIVES: This study evaluated the ability of dual-source computed tomography (DSCT) to detect coronary allograft vasculopathy (CAV) in heart transplant recipients using intravascular ultrasound (IVUS) as the standard of reference.

METHODS: Thirty patients with heart transplants (81% men, mean age 40 years) underwent DSCT (330-ms gantry rotation, 2 x 64 x 0.6-mm collimation, 60- to 80-ml contrast agent, no additional beta blockers) before invasive coronary angiography including IVUS of 1 vessel. Detection of CAV by DSCT was qualitatively defined as the presence of any coronary plaque.

RESULTS: Mean heart rate during dual-source computed tomographic scanning was 80 +/- 14 beats/min. Four hundred fifty-nine segments with a vessel caliber >1.5 mm according to quantitative coronary angiography were evaluated in 30 patients. Of these, 96% were considered to have excellent or good image quality. IVUS detected CAV in 17 of 30 patients (57%) and in 41 of 110 coronary segments (37%). Compared to IVUS, sensitivity, specificity, positive and negative predictive values for the detection of CAV by DSCT were 85%, 84%, 76%, and 91%, respectively.

CONCLUSION: In conclusion, DSCT permits the investigation of transplant recipients concerning the presence of CAV with good image quality and high diagnostic accuracy. Brandon Parker Jersey

PMID: 19892049

Posted in Computed Tomography and tagged , , , .

2 Comments

  1. This publication, illustrates another promising non-invasive option for post transplant patients who undergo repeated invasive angiographies + IVUS during follow-up. Nonetheless, coronary allograft vasculopathy is a major concern after heart transplant and one should consider the relatively low risk associated with the gold standard (invasive angiogram + IVUS) in this specific group (at experienced centers) vs the option of CT angiography (with less than 100% NPV). If replicated, perhaps at least some of the angiograms during follow-up could be replaced by CTA (with a new generation, high resolution scanner).

  2. Two things to keep in mind are:

    1. Study was done using dual-source technology with a temporal resolution of a quarter-gantry rotation of 82 msec. This may be the most variable when assessing patients with difficulty in heart-rate control (due to denervation).

    2. Coronary allograft vasculopathy affects the entire vessel and small branches which are commonly not well evaluated by CTA.

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