Belmonte Marta, Paolisso Pasquale, Viscusi Michele Mattia, Beles Monika, Bergamaschi Luca, Sansonetti Angelo, Ohashi Hirofumi, Seki Ruiko, Gallinoro Emanuele, Esposito Giuseppe, Shumkova Monika, Leone Attilio, Masetti Marco, Barbato Emanuele, Verstreken Sofie, Dierckx Riet, Heggermont Ward, Van Keer Jan, Potena Luciano, Pizzi Carmine, Bartunek Jozeph, Vanderheyden Marc
Cardiovascular Center Aalst, Onze-Lieve-Vrouwziekenhuis (OLV) Clinic, Aalst, Belgium (M. Belmonte, P.P., M.M.V., M. Beles, H.O., R.S., G.E., M.S., R.D., W.H., J.V.K., J.B., M.V.).
Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy (M. Belmonte, M.M.V., G.E., A.L.).
Circ Cardiovasc Imaging. 2025 Jan;18(1):e017197. doi: 10.1161/CIRCIMAGING.124.017197. Epub 2025 Jan 7.
Coronary computed tomography angiography (CCTA) is emerging as a valuable tool for noninvasive surveillance of cardiac allograft vasculopathy (CAV) in patients with heart transplant (HTx). We assessed the diagnostic performance of a comprehensive CCTA-based approach compared with the invasive reference, which includes invasive coronary angiography, intravascular ultrasound, and fractional flow reserve, for detecting CAV.
This was a multicenter prospective study including 37 patients with HTx who underwent CCTA, invasive coronary angiography, intravascular ultrasound, and fractional flow reserve. The comprehensive CCTA-based approach included quantitative and qualitative plaque analysis and functional assessment by fractional flow reserve derived from coronary computed tomography. CAV was diagnosed based on invasive coronary angiography (International Society for Heart and Lung Transplantation criteria) and intravascular ultrasound. Univariable logistic regression analysis was performed to test CCTA-derived predictors of CAV. The area under the curve and accuracy indicators were calculated to evaluate the performance and best cutoffs of CCTA predictors of CAV.
The median interval between CCTA and HTx was 5 years. Among the 37 recipients, 23 (62.2%) were diagnosed with CAV. The integration of diameter stenosis and plaque morphology (including plaque burden at minimum lumen area >42% and percent atheroma volume >23%) at CCTA yielded the highest diagnostic performance (accuracy, 84%; sensitivity, 83%; specificity, 86%). The integration of ∆fractional flow reserve derived from coronary computed tomography trans-vessel gradient led to increased sensitivity, albeit with decreased specificity and overall accuracy. The noninvasive approach was associated with a lower contrast and radiation dose, compared with the invasive approach.
A noninvasive strategy based on CCTA is accurate for managing patients with HTx. CCTA might be considered the preferred imaging modality for annual CAV surveillance after the first year post-HTx.
冠状动脉计算机断层扫描血管造影（CCTA）正成为心脏移植（HTx）患者心脏移植血管病变（CAV）无创监测的重要工具。我们评估了一种基于CCTA的综合方法与侵入性参考方法（包括侵入性冠状动脉造影、血管内超声和血流储备分数）在检测CAV方面的诊断性能。
这是一项多中心前瞻性研究，纳入了37例接受CCTA、侵入性冠状动脉造影、血管内超声和血流储备分数检查的HTx患者。基于CCTA的综合方法包括定量和定性斑块分析以及通过冠状动脉计算机断层扫描得出的血流储备分数进行功能评估。根据侵入性冠状动脉造影（国际心肺移植学会标准）和血管内超声诊断CAV。进行单变量逻辑回归分析以测试CCTA得出的CAV预测指标。计算曲线下面积和准确性指标以评估CCTA预测CAV的性能和最佳临界值。
CCTA与HTx之间的中位间隔时间为5年。在37例接受者中，23例（62.2%）被诊断为CAV。CCTA时直径狭窄和斑块形态（包括最小管腔面积处的斑块负荷>42%和动脉粥样硬化体积百分比>23%）相结合产生了最高的诊断性能（准确性，84%；敏感性，83%；特异性，86%）。冠状动脉计算机断层扫描跨血管梯度得出的∆血流储备分数相结合导致敏感性增加，尽管特异性和总体准确性降低。与侵入性方法相比，无创方法的造影剂和辐射剂量更低。
基于CCTA的无创策略在管理HTx患者方面是准确的。CCTA可被视为HTx后第一年之后每年进行CAV监测的首选成像方式。
