Perspective:

Yearly screening to identify CAV in patients with a heart transplant is recommended, and ICA is often used as a means to identify this at an early stage. Disadvantages of ICA include the need for an invasive procedure with its inherent risks and costs, and visualization that is limited to the vessel lumen, unless IVUS is also performed. CCTA represents a noninvasive means to assess luminal stenosis, and can also visualize the vessel wall and plaque in a manner similar to IVUS, although with a lower spatial resolution. The present study finds that CCTA has high accuracy to identify and exclude the presence of any stenosis or significant stenosis as compared to ICA, and has a moderate accuracy to identify intimal thickening in comparison to IVUS. Limitations of CCTA include the need for larger contrast volume as compared to ICA, which may be problematic in patients with renal insufficiency. Further, some of these studies excluded a proportion of patients with nondiagnostic CCTA studies from analyses, and individuals with significant cardiac arrhythmias were excluded from all studies. Finally, these studies excluded small segments, which are often poorly visualized on CCTA given the limits of spatial resolution, but which may demonstrate CAV in early stages. These findings suggest that CCTA may be a reasonable alternative in some patients who might otherwise undergo ICA, provided there is careful attention paid to appropriate patient selection.