CT Coronary Angiography and Dynamic CT Myocardial Perfusion for Detection of Cardiac Allograft Vasculopathy

Yura Ahn; Hyun Jung Koo; Junho Hyun; Sang Eun Lee; Sung Ho Jung; Duk-Woo Park; Jung-Min Ahn; Do-Yoon Kang; Seung-Jung Park; Hee Sang Hwang; Joon-Won Kang; Dong Hyun Yang; Jae-Joong Kim

doi:10.1016/j.jcmg.2022.12.031

CT Coronary Angiography and Dynamic CT Myocardial Perfusion for Detection of Cardiac Allograft Vasculopathy

JACC Cardiovasc Imaging. 2023 Jul;16(7):934-947. doi: 10.1016/j.jcmg.2022.12.031. Epub 2023 Apr 12.

Authors

Affiliations

¹ Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
² Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea. Electronic address: elfin19@gmail.com.
³ Division of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
⁴ Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
⁵ Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

PMID: 37407125
DOI: 10.1016/j.jcmg.2022.12.031

Abstract

Background: Cardiac allograft vasculopathy (CAV) is a major obstacle limiting long-term graft survival. Effective noninvasive surveillance modalities reflecting both coronary artery and microvascular components of CAV are needed.

Objectives: The authors evaluated the diagnostic performance of dynamic computed tomography-myocardial perfusion imaging (CT-MPI) and coronary computed tomography angiography (CCTA) for CAV.

Methods: A total of 63 heart transplantation patients 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 (MBF_global) and minimum MBF (MBF_min) 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.

Results: Among the 63 recipients, 35 (55.6%) had diagnoses of CAV. The median MBF_global and MBF_min 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 MBF_min 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 combination of CT-MPI and CCTA demonstrated excellent diagnostic performance for the detection of CAV. One-stop evaluation of the coronary artery and microvascular components involved in CAV using combined CCTA and CT-MPI may be a potent noninvasive screening method for early detection of CAV.

Keywords: cardiac allograft vasculopathy; cardiac computed tomography; computed tomography myocardial perfusion; heart transplantation; myocardial blood flow.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Allografts
Computed Tomography Angiography / methods
Coronary Angiography / methods
Coronary Artery Disease* / diagnostic imaging
Coronary Stenosis*
Humans
Myocardial Perfusion Imaging* / methods
Myocardium
Perfusion
Predictive Value of Tests
Tomography, X-Ray Computed / methods