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Cardiac CT for Detection of Cardiac Allograft Vasculopathy
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- Measurement of MBFmin provided high negative predictive value and, in combination with coronary stenosis on CCTA, resulted in excellent specificity and positive predictive value for the detection of cardiac allograft vasculopathy.
- These data suggest that the combination of CCTA and CT-MPI, allowing evaluation of both coronary artery and microvascular components of cardiac allograft vasculopathy, is an alternative noninvasive and cost-effective modality for the early detection of cardiac allograft vasculopathy.
- Additional studies are indicated to assess the predictive value of myocardial blood flow at baseline and its recovery rate during follow-up period for monitoring the development of cardiac allograft vasculopathy.
Study Questions:
What is the diagnostic performance of dynamic computed tomography–myocardial perfusion imaging (CT-MPI) and coronary computed tomography angiography (CCTA) for cardiac allograft vasculopathy (CAV)?
Methods:
The investigators analyzed a total of 63 heart transplantation patients who underwent combined CT-MPI and CCTA plus invasive coronary angiography (ICA) with intravascular ultrasonography (IVUS) between December 2018 and October 2021. The median interval between CT-MPI and heart transplantation was 4.3 years. Peak myocardial blood flow (MBF) of the whole myocardium (MBFglobal) and minimum MBF (MBFmin) among the 16 segments according to the American Heart Association model, except the left ventricular apex, were calculated from CT-MPI. CCTA was assessed qualitatively, and the degree of coronary artery stenosis was recorded. CAV was diagnosed based on both ICA (ISHLT criteria) and IVUS. Patients were followed up for a median time of 2.3 years after CT-MPI and a median time of 5.7 years after transplantation. Logistic regression analysis was used to obtain the predicted probability of CAV for combined coronary artery stenosis (binary variable) and MBFmin (continuous variable), and the receiver operating characteristic curve was plotted using that predicted probability.
Results:
Among the 63 recipients, 35 (55.6%) had diagnoses of CAV. The median MBFglobal and MBFmin were significantly lower in patients with CAV (128.7 vs. 150.4 mL/100 mL/min; p = 0.014; and 96.9 vs. 122.8 mL/100 mL/min; p < 0.001, respectively). The combined use of coronary artery stenosis on CCTA and MBFmin showed the highest diagnostic performance with an area under the curve of 0.886 (sensitivity: 74.3%, specificity: 96.4%, positive predictive value: 96.3%, and negative predictive value: 75.0%).
Conclusions:
The authors report that the combination of CT-MPI and CCTA demonstrated excellent diagnostic performance for the detection of CAV.
Perspective:
This study reports that measurement of MBFmin provided high negative predictive value and, in combination with coronary stenosis on CCTA, resulted in excellent specificity and positive predictive value for the detection of CAV, including angiographically obscure CAV. These data suggest that the combination of CCTA and CT-MPI, allowing evaluation of both coronary artery and microvascular components of CAV, is an alternative noninvasive and cost-effective modality for the early detection of CAV. Additional studies are indicated to assess the predictive value of myocardial blood flow at baseline and its recovery rate during follow-up period for monitoring the development of CAV.
Clinical Topics: Cardiac Surgery, Cardiovascular Care Team, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Prevention, Cardiac Surgery and Arrhythmias, Cardiac Surgery and Heart Failure, Acute Heart Failure, Heart Transplant, Interventions and Imaging, Angiography, Computed Tomography, Echocardiography/Ultrasound, Nuclear Imaging
Keywords: Allografts, Cardiac Surgical Procedures, Computed Tomography Angiography, Tomography, X-Ray Computed, Coronary Angiography, Coronary Stenosis, Diagnostic Imaging, Heart Failure, Heart Transplantation, Myocardium, Perfusion, Perfusion Imaging, Secondary Prevention, Tomography, Ultrasonography, Interventional
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