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Open Access 01-08-2020 | Angiography | Cardiac

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

Published in: European Radiology | Issue 8/2020

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.

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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
Publication date: 01-08-2020
Publisher: Springer Berlin Heidelberg
Keywords: Angiography
Heart Transplantation
Intravascular Ultrasound
Heart Transplantation
Heart Transplantation
CT Angiography
Heart Transplantation
Heart Transplantation
Published in: European Radiology / Issue 8/2020
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-019-06653-3

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

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

Abstract

Objectives

Methods

Results

Conclusion

Key Points

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusion

Key Points

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