Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Current Cardiovascular Imaging Reports
Published in: Current Cardiovascular Imaging Reports 11/2018

Open Access 01-11-2018 | Cardiac Computed Tomography (M Cheezum and B Chow, Section Editors)

Coronary CTA for Surveillance of Cardiac Allograft Vasculopathy

Authors: Nishant R. Shah, Ron Blankstein, Todd Villines, Hafiz Imran, Alan R. Morrison, Michael K. Cheezum

Published in: Current Cardiovascular Imaging Reports | Issue 11/2018

Login to get access

Abstract

Purpose of Review

The purpose of this review is to highlight recent hardware and software advances in coronary computed tomography angiography (CTA) that make it a potentially viable alternative to invasive coronary angiography for surveillance of cardiac allograft vasculopathy (CAV) in heart transplant recipients.

Recent Findings

Dual-source CT, multisegment reconstruction, and intracycle motion correction algorithms are all technologies applied during or after image acquisition that can improve image quality and diagnostic accuracy in patients with elevated heart rates, such as heart transplant recipients. CT fractional flow reserve may also add value in this clinical scenario.

Summary

Coronary CTA now has equivalent diagnostic accuracy, offers more nuanced anatomic information, is inherently safer, and could be less costly than invasive coronary angiography. For these reasons, coronary CTA may now be a viable alternative to ICA for CAV surveillance in heart transplant recipients.
Literature
1.
Lund LH, Khush KK, Cherikh WS, et al. The Registry of the International Society for Heart and Lung Transplantation: thirty-fourth adult heart transplantation report-2017; focus theme: allograft ischemic time. J Heart Lung Transplant. 2017;36:1037–46.CrossRefPubMed
2.
Salomon RN, Hughes CC, Schoen FJ, Payne DD, Pober JS, Libby P. Human coronary transplantation-associated arteriosclerosis. Evidence for a chronic immune reaction to activated graft endothelial cells. Am J Pathol. 1991;138:791–8.PubMedPubMedCentral
3.
4.
Schoen FJ, Libby P. Cardiac transplant graft arteriosclerosis. Trends Cardiovasc Med. 1991;1:216–23.CrossRefPubMed
5.
Mehra MR, Crespo-Leiro MG, Dipchand A, et al. International Society for Heart and Lung Transplantation working formulation of a standardized nomenclature for cardiac allograft vasculopathy-2010. J Heart Lung Transplant. 2010;29:717–27.CrossRefPubMed
6.
•• Costanzo MR, Dipchand A, Starling R et al. The International Society of Heart and Lung Transplantation Guidelines for the care of heart transplant recipients. The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation 2010;29:914-56. Key Reference: Guideline that established annual or biannual invasive coronary angiography as the preferred strategy for cardiac allograft vasculopathy surveillance.
7.
St Goar FG, Pinto FJ, Alderman EL, et al. Intracoronary ultrasound in cardiac transplant recipients. In vivo evidence of “angiographically silent” intimal thickening. Circulation. 1992;85:979–87.CrossRefPubMed
8.
Fearon WF, Nakamura M, Lee DP, et al. Simultaneous assessment of fractional and coronary flow reserves in cardiac transplant recipients: Physiologic Investigation for Transplant Arteriopathy (PITA Study). Circulation. 2003;108:1605–10.CrossRefPubMed
9.
Haddad F, Khazanie P, Deuse T, et al. Clinical and functional correlates of early microvascular dysfunction after heart transplantation. Circ Heart Fail. 2012;5:759–68.CrossRefPubMed
10.
Maurovich-Horvat P, Ferencik M, Voros S, Merkely B, Hoffmann U. Comprehensive plaque assessment by coronary CT angiography. Nat Rev Cardiol. 2014;11:390–402.CrossRefPubMed
11.
Nunoda S, Machida H, Sekikawa A, et al. Evaluation of cardiac allograft vasculopathy by multidetector computed tomography and whole-heart magnetic resonance coronary angiography. Circ J. 2010;74:946–53.CrossRefPubMed
12.
Dehmer GJ, Weaver D, Roe MT, et al. A contemporary view of diagnostic cardiac catheterization and percutaneous coronary intervention in the United States: a report from the CathPCI Registry of the National Cardiovascular Data Registry, 2010 through June 2011. J Am Coll Cardiol. 2012;60:2017–31.CrossRefPubMed
13.
Agostoni P, Biondi-Zoccai GG, de Benedictis ML, et al. Radial versus femoral approach for percutaneous coronary diagnostic and interventional procedures; systematic overview and meta-analysis of randomized trials. J Am Coll Cardiol. 2004;44:349–56.CrossRefPubMed
14.
Kalisz K, Buethe J, Saboo SS, Abbara S, Halliburton S, Rajiah P. Artifacts at cardiac CT: physics and solutions. Radiographics. 2016;36:2064–83.CrossRefPubMed
15.
Abbara S, Blanke P, Maroules CD, et al. SCCT guidelines for the performance and acquisition of coronary computed tomographic angiography: a report of the society of Cardiovascular Computed Tomography Guidelines Committee: endorsed by the North American Society for Cardiovascular Imaging (NASCI). J Cardiovasc Comput Tomogr. 2016;10:435–49.CrossRefPubMed
16.
Flohr TG, McCollough CH, Bruder H, et al. First performance evaluation of a dual-source CT (DSCT) system. Eur Radiol. 2006;16:256–68.CrossRefPubMed
17.
•• Achenbach S, Manolopoulos M, Schuhback A, et al. Influence of heart rate and phase of the cardiac cycle on the occurrence of motion artifact in dual-source CT angiography of the coronary arteries. J Cardiovasc Comput Tomogr. 2012;6:91–8 Key Reference: Patient series showing that images reconstructed during late systole more frequently provide the best image quality in patients with higher heart rates undergoing dual-source coronary CTA. CrossRefPubMed
18.
Ropers U, Ropers D, Pflederer T, et al. Influence of heart rate on the diagnostic accuracy of dual-source computed tomography coronary angiography. J Am Coll Cardiol. 2007;50:2393–8.CrossRefPubMed
19.
Brodoefel H, Burgstahler C, Tsiflikas I, et al. Dual-source CT: effect of heart rate, heart rate variability, and calcification on image quality and diagnostic accuracy. Radiology. 2008;247:346–55.CrossRefPubMed
20.
Manzke R, Grass M, Nielsen T, Shechter G, Hawkes D. Adaptive temporal resolution optimization in helical cardiac cone beam CT reconstruction. Med Phys. 2003;30:3072–80.CrossRefPubMed
21.
•• Sigurdsson G, Carrascosa P, Yamani MH, et al. Detection of transplant coronary artery disease using multidetector computed tomography with adaptative multisegment reconstruction. J Am Coll Cardiol. 2006;48:772–8 Key Reference: Patient series showing that detection of occlusive coronary disease in heart transplant recipients with elevated resting heart rates by multidetector CT is feasible using multicycle reconstruction. CrossRefPubMed
22.
Leipsic J, Labounty TM, Hague CJ, et al. Effect of a novel vendor-specific motion-correction algorithm on image quality and diagnostic accuracy in persons undergoing coronary CT angiography without rate-control medications. J Cardiovasc Comput Tomogr. 2012;6:164–71.CrossRefPubMed
23.
Li ZN, Yin WH, Lu B, et al. Improvement of image quality and diagnostic performance by an innovative motion-correction algorithm for prospectively ECG triggered coronary CT angiography. PLoS One. 2015;e0142796:10.
24.
•• Andreini D, Lin FY, Rizvi A, et al. Diagnostic performance of a novel coronary CT angiography algorithm: prospective multicenter validation of an intracycle CT motion correction algorithm for diagnostic accuracy. AJR Am J Roentgenol. 2018;210:1208–15 Key Reference: Prospective multicenter trial showing that a motion correction algorithm applied during coronary CTA reconstruction can reduce artifacts and improve diagnostic performance for obstructive coronary artery disease on a per-vessel basis and on a per-subject basis in patients with elevated heart rates. CrossRefPubMed
25.
•• Wever-Pinzon O, Romero J, Kelesidis I, et al. Coronary computed tomography angiography for the detection of cardiac allograft vasculopathy: a meta-analysis of prospective trials. J Am Coll Cardiol. 2014;63:1992–2004 Key Reference: Meta-analysis that shows current coronary CTA technology has excellent sensitivity, specificity, and negative predictive value compared to invasive coronary angiography for the detection of cardiac allograft vasculopathy. CrossRefPubMed
26.
Mittal TK, Panicker MG, Mitchell AG, Banner NR. Cardiac allograft vasculopathy after heart transplantation: electrocardiographically gated cardiac CT angiography for assessment. Radiology. 2013;268:374–81.CrossRefPubMed
27.
Taylor CA, Fonte TA, Min JK. Computational fluid dynamics applied to cardiac computed tomography for noninvasive quantification of fractional flow reserve: scientific basis. J Am Coll Cardiol. 2013;61:2233–41.CrossRefPubMed
28.
Norgaard BL, Leipsic J, Gaur S, et al. Diagnostic performance of noninvasive fractional flow reserve derived from coronary computed tomography angiography in suspected coronary artery disease: the NXT trial (Analysis of Coronary Blood Flow Using CT Angiography: Next Steps). J Am Coll Cardiol. 2014;63:1145–55.CrossRefPubMed
29.
•• Douglas PS, Pontone G, Hlatky MA, et al. Clinical outcomes of fractional flow reserve by computed tomographic angiography-guided diagnostic strategies vs. usual care in patients with suspected coronary artery disease: the prospective longitudinal trial of FFR(CT): outcome and resource impacts study. Eur Heart J. 2015;36:3359–67 Key Reference: Landmark trial that showed coronary CTA with fractional flow reserve is a feasible and safe alternative to invasive coronary angiography and is associated with a significantly lower rate of invasive angiography showing no obstructive coronary artery disease. CrossRefPubMedPubMedCentral
30.
Bravo PE, Bergmark BA, Vita T, et al. Diagnostic and prognostic value of myocardial blood flow quantification as non-invasive indicator of cardiac allograft vasculopathy. Eur Heart J. 2018;39:316–23.CrossRefPubMed
31.
Chih S, Chong AY, Erthal F, et al. PET assessment of epicardial intimal disease and microvascular dysfunction in cardiac allograft vasculopathy. J Am Coll Cardiol. 2018;71:1444–56.CrossRefPubMed
Metadata
Title
Coronary CTA for Surveillance of Cardiac Allograft Vasculopathy
Authors
Nishant R. Shah
Ron Blankstein
Todd Villines
Hafiz Imran
Alan R. Morrison
Michael K. Cheezum
Publication date
01-11-2018
Publisher
Springer US
Published in
Current Cardiovascular Imaging Reports / Issue 11/2018
Print ISSN: 1941-9066
Electronic ISSN: 1941-9074
DOI
https://doi.org/10.1007/s12410-018-9467-z

Other articles of this Issue 11/2018

Current Cardiovascular Imaging Reports 11/2018 Go to the issue

Echocardiography (F Asch and S Costa, Section Editors)

The Comprehensive Assessment of Left Ventricular Assist Devices by Echocardiography

Echocardiography (F Asch and S Costa, Section Editors)

A Review of Echocardiography Training for Internal Medicine Residents: Proposed Goals, Methods, and Metrics

Cardiac Computed Tomography (M Cheezum and B Chow, Section Editors)

Utility of Cardiac Computed Tomography in Patients with Left Ventricular Assist Devices

Echocardiography (F Asch and S Costa, Section Editors)

Comprehensive Assessment of Aortic Stenosis in the TAVR Era

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

Watch now

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits