Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Eur J Radiol. 2021 Oct;143:109886. doi: 10.1016/j.ejrad.2021.109886. Epub 2021 Jul 31.
Assess and compare the quality and diagnostic performance of CCTA between pre-liver and pre-kidney transplant patients, and gauge impact of CCTA on ICA requirements.
Patients without known coronary artery disease (CAD) were selected for CCTA if considered high-risk or after abnormal stress testing. All pre-liver and pre-kidney CCTAs between March 2018 and August 2020 were retrospectively included. CCTA quality was qualitatively graded as excellent/good/fair/poor, and CAD graded as < or ≥50% stenosis. Heart rate, coronary artery calcium (CAC) scores, and fractional flow reserve CT (FFR) results were collected. CAD stenosis was graded on invasive coronary angiogram (ICA) images, with ≥50% stenosis defined as significant.
162 pre-transplant patients (91 pre-liver, 71 pre-kidney). Pre-kidney patients had poorer CCTA quality (p = 0.04) and higher heart rate (median: 65 bpm vs 60 bpm, p < 0.001). Out of 147 diagnostic CCTAs (pre-liver: 84, pre-kidney: 63), 73 (49.7%) had a ≥50% stenosis (pre-liver: 38 (45.2%), pre-kidney:35 (55.6%)). 12/38 (31.6%) had a significantly reduced FFR, and 19/53 (35.8%) had ≥50% stenosis on ICA. Among patients whose CCTA was diagnostic and had ICA, stenosis severity was concordant in 10/23 (43.5%) pre-liver and 10/25 (40%) pre-kidney patients. All discordant cases had stenosis 'over-called' on CCTA.
Diagnostic-quality CCTAs in high-risk pre-transplant patients are achievable and can greatly reduce ICA requirements by excluding significant CAD. CCTA quality is poorer in pre-kidney transplant patients compared to pre-liver, possibly due to higher heart rate.
评估和比较肝前和肾前移植患者 CCTA 的质量和诊断性能，并评估 CCTA 对 ICA 要求的影响。
如果认为高风险或应激试验异常，则选择无已知冠状动脉疾病 (CAD) 的患者进行 CCTA。回顾性纳入 2018 年 3 月至 2020 年 8 月期间所有肝前和肾前 CCTA。CCTA 质量定性分级为优秀/良好/一般/差，CAD 分级为<或≥50%狭窄。收集心率、冠状动脉钙 (CAC) 评分和血流储备分数 CT (FFR) 结果。在侵入性冠状动脉造影 (ICA) 图像上对 CAD 狭窄程度进行分级，以≥50%狭窄定义为显著。
共纳入 162 例移植前患者（肝前 91 例，肾前 71 例）。肾前患者的 CCTA 质量较差（p=0.04），心率较高（中位数：65bpm 比 60bpm，p<0.001）。在 147 例诊断性 CCTA 中（肝前：84 例，肾前：63 例），73 例（49.7%）有≥50%狭窄（肝前：38 例[45.2%]，肾前：35 例[55.6%]）。12/38 例（31.6%）有明显降低的 FFR，19/53 例（35.8%）有 ICA 上≥50%狭窄。在 CCTA 诊断且有 ICA 的患者中，23 例肝前患者中有 10 例（43.5%）和 25 例肾前患者中有 10 例（40%）狭窄严重程度一致。所有不一致的病例 CCTA 均存在狭窄程度“高估”。
在高危移植前患者中，可获得诊断质量的 CCTA，并通过排除严重 CAD 大量减少 ICA 要求。与肝前移植患者相比，肾前移植患者的 CCTA 质量较差，可能是由于心率较高。
