Department of Cardiology, Ludwig-Maximilians University, Grosshadern Campus, Munich, Germany.
Transplantation. 2011 Aug 27;92(4):493-8. doi: 10.1097/TP.0b013e318225281d.
Cardiac allograft vasculopathy (CAV) still limits survival after heart transplantation. Currently available noninvasive tests are of inferior value to detect CAV, and thus invasive coronary angiography (ICA) is frequently performed. Cardiac dual-source computed tomography calcium scoring (DSCTCS) offers the possibility to detect coronary calcifications, which might serve as a noninvasive marker of CAV. This study sought to evaluate its clinical feasibility.
One hundred sixty-one patients (130 men; 31 women; mean age: 50.5±12.1 years) underwent DSCTCS 1±2 days before annual routine ICA. Mean posttransplant time was 73.7±49.6 months. The results of DSCTCS were compared with ICA.
In 100 patients (85 men; 15 women; mean age: 51.5±12.3 years), coronary calcifications were detected, and in 61 patients (45 men; 16 women; mean age: 49.0±11.7 years), coronary calcifications were excluded. ICA excluded CAV in 82 patients (63 men; 19 women; mean age: 48.6±11.9 years). In 79 patients (67 men; 12 women; mean age: 52.5±12.2 years), CAV was detected of whom 11 patients needed stent implantation. No statistically significant difference of DSCTCS in patients without (17.2±29.5; range: 0-190) and with CAV (33.4±66.8; range: 0-385) was observed (P=0.133). Moreover, 4 of 11 (36.4%) severely diseased patients had a calcium score of zero. Sensitivity, specificity, negative predictive value, and positive predictive value for CAV detection (calcium score threshold >0) was calculated as 72.2%, 47.6%, 47.7%, and 57.0%, respectively. Diagnostic accuracy was 59.6%.
DSCTCS is not a valuable noninvasive modality for CAV detection and thus not recommended in clinical practice. Moreover, we hypothesize that it represents preexisting or de novo traditional coronary atherosclerosis than CAV.
心脏同种异体移植血管病（CAV）仍然限制了心脏移植后的生存。目前可用的非侵入性检查对检测 CAV 的价值较低，因此经常进行有创冠状动脉造影（ICA）。心脏双源 CT 钙评分（DSCTCS）提供了检测冠状动脉钙化的可能性，冠状动脉钙化可能是 CAV 的一种非侵入性标志物。本研究旨在评估其临床可行性。
161 例患者（130 例男性；31 例女性；平均年龄：50.5±12.1 岁）在每年例行 ICA 前 1±2 天行 DSCTCS。平均移植后时间为 73.7±49.6 个月。将 DSCTCS 的结果与 ICA 进行比较。
在 100 例患者（85 例男性；15 例女性；平均年龄：51.5±12.3 岁）中，检测到冠状动脉钙化，在 61 例患者（45 例男性；16 例女性；平均年龄：49.0±11.7 岁）中，排除了冠状动脉钙化。ICA 在 82 例患者（63 例男性；19 例女性；平均年龄：48.6±11.9 岁）中排除了 CAV。在 79 例（67 例男性；12 例女性；平均年龄：52.5±12.2 岁）有 CAV 的患者中，有 11 例需要植入支架。无统计学意义差异的 DSCTCS 在患者无（17.2±29.5；范围：0-190）和有 CAV（33.4±66.8；范围：0-385）之间观察到（P=0.133）。此外，11 例严重病变患者中有 4 例钙评分值为零。CAV 检测的敏感性、特异性、阴性预测值和阳性预测值（钙评分阈值>0）分别为 72.2%、47.6%、47.7%和 57.0%。诊断准确性为 59.6%。
DSCTCS 对 CAV 的检测不是一种有价值的非侵入性方法，因此不建议在临床实践中使用。此外，我们假设它代表了预先存在的或新出现的传统冠状动脉粥样硬化，而不是 CAV。
