Poland: Heart transplantation stands as a life-saving intervention for individuals with end-stage heart failure. Yet, even after a successful transplant, recipients face ongoing challenges, including the risk of cardiac allograft vasculopathy (CAV), a form of coronary artery disease unique to transplant patients. In this context, the utility of advanced imaging techniques like 64-slice coronary computed tomography angiography (CCTA) is gaining significant attention for its potential to revolutionize post-transplant care.
The study, published in Transplantation Proceedings, revealed the effectiveness of coronary CT angiography in assessing cardiac allograft vasculopathy risk in heart transplant patients. The researchers found that heart transplant patients followed with CCTA exams had no adverse events.
"CCTA offers a secure and efficient means of assessment in heart transplant recipients," the researchers wrote.
CAV remains a leading cause of morbidity and mortality in heart transplant recipients, often presenting insidiously and progressing silently. Traditional diagnostic modalities, such as coronary angiography, may have limitations in detecting early stages of CAV due to the complex anatomy of the transplanted heart and the presence of coronary artery anomalies. However, 64-slice CCTA offers a non-invasive and highly accurate alternative for evaluating coronary vasculature with exceptional spatial resolution.
Against the above background, Agnieszka Kuczaj, Medical University of Silesia, Katowice, Poland, and colleagues aimed to evaluate the safety and efficacy of CCTA in patients after heart transplantation (HTx).
For this purpose, the researchers enrolled 107 consecutive HTx recipients (26 women, mean age 50 ± 17 years); all were ≥3 years post-HTx with no or minimal evidence of CAV in a prior coronary angiography performed a minimum of 2 years before the current examination.
The inclusion criteria comprised the absence of new heart failure symptoms, an estimated glomerular filtration rate (eGFR) of ≥30, and no contraindications to iodine contrast or CT scans.
All patients underwent a 64-slice CCTA. Noninvasive follow-up examinations were conducted in cases of no or minimal changes. Significant changes in CT prompted additional coronary angiography.
The study led to the following findings:
Of the enrolled participants, 9 exhibited minimal changes; 98 displayed no changes in coronary angiography.
The median time since transplant was 7 years, with IQR of 4 to 11.25 years. Significant changes were excluded in 98 patients.
Among the nine patients with suspected significant CAV, significant changes were confirmed in 8 patients, resulting in percutaneous transluminal coronary angioplasty (PTCA) performed in 6.
One patient from this group died shortly after PTCA. There were no cardiovascular incidents within the remaining group.
The median follow-up period was 539. The mean left ventricular ejection fraction at follow-up was 58% ± 5% compared with 58% ± 4% at baseline.
At follow-up, the mean eGFR was 64 ± 18 mL/kg/1.73 m2 compared with the baseline value of 67.2 mL/kg/1.73 m2.
"CCTA is a safe method of evaluating cardiac allograft vasculopathy risk in heart transplant recipients," the researchers concluded.
Reference:
Kuczaj, A., Pawlak, S., Głowacki, J., Antończyk, R., Śliwka, J., Przybyłowski, P., & Hrapkowicz, T. (2024). Utility of 64-Slice Coronary Computed Tomography Angiography in Heart Transplant Recipients. Transplantation Proceedings. https://doi.org/10.1016/j.transproceed.2024.03.035