Department of Medicine, Tokyo Women's Medical University Medical Center East, Tokyo, Japan.
Circ J. 2010 May;74(5):946-53. doi: 10.1253/circj.cj-09-0800. Epub 2010 Mar 10.
Cardiac allograft vasculopathy (CAV) is a major complication that limits the long-term survival of recipients of heart transplants. In the present study the feasibility of 2 noninvasive approaches for detecting CAV (multidetector computed tomography (MDCT) and whole-heart magnetic resonance coronary angiography (MRCA)) was compared with conventional coronary angiography (CCAG).
Of 22 heart transplant recipients who underwent CCAG screening, 13 had only MDCT, 16 had only MRCA, and 7 had both noninvasive modalities. The coronary arterial tree was divided into 9 segments. Detection of vasculopathy by coronary segments was compared between 16-/64-detector computed tomography (CT) or MRCA and CCAG. The sensitivity of both 16- and 64-detector CT for diagnosing CAV was 69.6%, and specificity was 96.8%. The sensitivity and specificity by 64-detector CT alone were 90.0% and 97.5%, respectively; its positive and negative predictive values were 81.8% and 98.7% respectively. For MRCA, sensitivity was 60%, specificity, 100%, positive predictive value, 100% and negative predictive value, 92.2%. MRCA showed no false positives.
MDCT, especially 64-detector CT, is feasible for detecting CAV, whereas MRCA currently shows limited sensitivity.
心脏移植后，心脏供体的血管病变（CAV）是限制受者长期存活的主要并发症。本研究旨在比较多排螺旋 CT（MDCT）和全心脏磁共振冠状动脉造影（MRCA）两种非侵入性方法检测 CAV 的可行性，并与传统冠状动脉造影（CCAG）进行比较。
在接受 CCAG 筛查的 22 例心脏移植受者中，13 例仅行 MDCT，16 例仅行 MRCA，7 例同时行两种非侵入性检查。将冠状动脉树分为 9 个节段。比较 16 层和 64 层 CT 或 MRCA 与 CCAG 对血管病变的检测情况。16 层和 64 层 CT 诊断 CAV 的敏感性分别为 69.6%和 96.8%，特异性分别为 96.8%和 97.5%。64 层 CT 单独检查的敏感性和特异性分别为 90.0%和 97.5%，阳性预测值和阴性预测值分别为 81.8%和 98.7%。MRCA 的敏感性为 60%，特异性为 100%，阳性预测值为 100%，阴性预测值为 92.2%。MRCA 无假阳性。
MDCT，尤其是 64 层 CT，可用于检测 CAV，而 MRCA 目前敏感性有限。
