Department of Radiology, Cardio-Thoracic Surgical Center Marie Lannelongue, 133 Avenue de la Resistance, 92 350 LePlessis Robinson, France.
Transplantation. 2011 Mar 15;91(5):583-8. doi: 10.1097/TP.0b013e3182088b96.
We evaluate the feasibility and safety of coronary computed tomography angiography (CCTA) as the first-line investigation in heart transplant patients and the rate of coronary allograft vasculopathy detected using CCTA.
From September 2003 to June 2009, we prospectively included 65 heart transplant recipients, retaining 62 who underwent yearly CCTA for coronary allograft vasculopathy detection (261 CCTAs). We used 16-slice, 64-slice, and 2×64-slice CT machines. Patients with coronary artery stenosis by CCTA had a confirmation and a further follow-up exclusively by conventional coronary angiography (CCA).
No major coronary events occurred during the study. Of the 62 baseline CCTAs, 37 (60%) were normal, 18 (29%) showed wall thickening, and 7 (11%) known significant stenosis, confirmed by CCA. The mean follow-up duration was 5 years. At the last follow-up, 26 (70%) patients with normal baseline findings remained normal, 9 (24%) had wall thickening, and 2 (6%) significant stenoses. Time to stenosis was consistently greater than 3 years. Of the 18 patients with initially wall thickening, 14 (78%) had wall thickening and 4 (22%) significant stenosis at last follow-up. The mean interval without any coronary lesion was 9.46±3.98 years. The mean interval without de novo significant stenosis was 10.31±4 years.
CCTA seems to be a safe noninvasive tool for monitoring heart transplant patients, and thus obviating the need for CCA. In patients with normal baseline CCTA, a 2-year interval between CCTAs may be safe.
我们评估了冠状动脉计算机断层扫描血管造影术（CCTA）作为心脏移植患者一线检查的可行性和安全性，以及使用 CCTA 检测到的冠状动脉移植物血管病变的发生率。
从 2003 年 9 月至 2009 年 6 月，我们前瞻性地纳入了 65 例心脏移植受者，保留了 62 例每年接受 CCTA 检测冠状动脉移植物血管病变的患者（261 例 CCTA）。我们使用了 16 层、64 层和 2×64 层 CT 机。CCTA 显示冠状动脉狭窄的患者仅通过常规冠状动脉造影（CCA）进行了确认和进一步随访。
在研究期间没有发生重大冠状动脉事件。在 62 例基线 CCTA 中，37 例（60%）正常，18 例（29%）显示壁增厚，7 例（11%）已知存在明显狭窄，通过 CCA 证实。平均随访时间为 5 年。在最后一次随访时，26 例（70%）基线正常的患者仍保持正常，9 例（24%）有壁增厚，2 例（6%）有明显狭窄。狭窄时间始终大于 3 年。在最初有壁增厚的 18 例患者中，14 例（78%）在最后一次随访时仍有壁增厚，4 例（22%）有明显狭窄。无任何冠状动脉病变的平均间隔为 9.46±3.98 年。无新发明显狭窄的平均间隔为 10.31±4 年。
CCTA 似乎是一种安全的非侵入性工具，可用于监测心脏移植患者，从而避免了 CCA 的需要。在基线 CCTA 正常的患者中，两次 CCTA 之间间隔 2 年可能是安全的。
