Clinical implementation of coronary computed tomography angiography for routine detection of cardiac allograft vasculopathy in heart transplant patients

Fay M.A. Nous; Stefan Roest; Eva D. van Dijkman; Mohamed Attrach; Kadir Caliskan; Jasper J. Brugts; Koen Nieman; Alexander Hirsch; Alina A. Constantinescu; Olivier C. Manintveld; Ricardo P.J. Budde

doi:10.1111/tri.13973

Clinical implementation of coronary computed tomography angiography for routine detection of cardiac allograft vasculopathy in heart transplant patients

Fay M.A. Nous, Stefan Roest, Eva D. van Dijkman, Mohamed Attrach, Kadir Caliskan, Jasper J. Brugts, Koen Nieman, Alexander Hirsch, Alina A. Constantinescu, Olivier C. Manintveld, Ricardo P.J. Budde^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

Cardiac allograft vasculopathy (CAV) is an accelerated form of coronary artery disease that affects long-term outcomes in heart transplant (HTx) patients. We prospectively evaluated the feasibility of coronary computed tomography angiography (CCTA) for the detection of CAV during clinical implementation at our center. All consecutive HTx patients >4 years post-transplant were actively converted from myocardial perfusion imaging to CCTA for the annual assessment of CAV. Between February 2018 and May 2019, 129/172 (75%) HTx patients underwent a CCTA. Renal impairment (n = 21/43) was the most frequent reason for patients could not undergo CCTA. CCTA image quality was good–excellent in 118/129 (92%) patients, and the radiation dose was 2.1 (1.6–2.8) mSv. CCTA showed obstructive CAV in 19/129 (15%) patients. Thirteen (10%) patients underwent additional tests, of which 8 patients underwent coronary revascularization within 90 days of CCTA. After 1 year, 3 additional coronary angiograms were performed, resulting in one revascularization in a patient with known severe CAV who developed ventricular tachycardia. One myocardial infarction after coronary stenting and 2 non-cardiac deaths were observed. CCTA can be successfully implemented for routine detection of CAV with good image quality and low radiation dose. CCTA allows CAV evaluation with the limited need for additional invasive testing.

Original language	English
Pages (from-to)	1886-1894
Number of pages	9
Journal	Transplant International
Volume	34
Issue number	10
DOIs	https://doi.org/10.1111/tri.13973
Publication status	Published - Oct 2021

Bibliographical note

Funding Information:
Dr. Budde reports institutional research support to the Erasmus MC from Siemens Healthineers outside he submitted work. Dr. Nieman reports unrestricted institutional grants from Siemens Healthineers, Bayer, and HeartFlow Inc., outside the submitted work. All other authors have not to disclose.

Publisher Copyright:
© 2021 The Authors. Transplant International published by John Wiley & Sons Ltd on behalf of Steunstichting ESOT

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Clinical implementation of coronary computed tomography angiography for routine detection of cardiac allograft vasculopathy in heart transplant patientsFinal published version, 385 KBLicence: CC BY-NC-ND

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Nous, F. M. A., Roest, S., van Dijkman, E. D., Attrach, M., Caliskan, K., Brugts, J. J., Nieman, K., Hirsch, A., Constantinescu, A. A., Manintveld, O. C., & Budde, R. P. J. (2021). Clinical implementation of coronary computed tomography angiography for routine detection of cardiac allograft vasculopathy in heart transplant patients. Transplant International, 34(10), 1886-1894. https://doi.org/10.1111/tri.13973

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title = "Clinical implementation of coronary computed tomography angiography for routine detection of cardiac allograft vasculopathy in heart transplant patients",

abstract = "Cardiac allograft vasculopathy (CAV) is an accelerated form of coronary artery disease that affects long-term outcomes in heart transplant (HTx) patients. We prospectively evaluated the feasibility of coronary computed tomography angiography (CCTA) for the detection of CAV during clinical implementation at our center. All consecutive HTx patients >4 years post-transplant were actively converted from myocardial perfusion imaging to CCTA for the annual assessment of CAV. Between February 2018 and May 2019, 129/172 (75%) HTx patients underwent a CCTA. Renal impairment (n = 21/43) was the most frequent reason for patients could not undergo CCTA. CCTA image quality was good–excellent in 118/129 (92%) patients, and the radiation dose was 2.1 (1.6–2.8) mSv. CCTA showed obstructive CAV in 19/129 (15%) patients. Thirteen (10%) patients underwent additional tests, of which 8 patients underwent coronary revascularization within 90 days of CCTA. After 1 year, 3 additional coronary angiograms were performed, resulting in one revascularization in a patient with known severe CAV who developed ventricular tachycardia. One myocardial infarction after coronary stenting and 2 non-cardiac deaths were observed. CCTA can be successfully implemented for routine detection of CAV with good image quality and low radiation dose. CCTA allows CAV evaluation with the limited need for additional invasive testing.",

author = "Nous, {Fay M.A.} and Stefan Roest and {van Dijkman}, {Eva D.} and Mohamed Attrach and Kadir Caliskan and Brugts, {Jasper J.} and Koen Nieman and Alexander Hirsch and Constantinescu, {Alina A.} and Manintveld, {Olivier C.} and Budde, {Ricardo P.J.}",

note = "Funding Information: Dr. Budde reports institutional research support to the Erasmus MC from Siemens Healthineers outside he submitted work. Dr. Nieman reports unrestricted institutional grants from Siemens Healthineers, Bayer, and HeartFlow Inc., outside the submitted work. All other authors have not to disclose. Publisher Copyright: {\textcopyright} 2021 The Authors. Transplant International published by John Wiley & Sons Ltd on behalf of Steunstichting ESOT",

year = "2021",

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doi = "10.1111/tri.13973",

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pages = "1886--1894",

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Nous, FMA, Roest, S, van Dijkman, ED, Attrach, M , Caliskan, K , Brugts, JJ, Nieman, K, Hirsch, A , Constantinescu, AA , Manintveld, OC & Budde, RPJ 2021, 'Clinical implementation of coronary computed tomography angiography for routine detection of cardiac allograft vasculopathy in heart transplant patients', Transplant International, vol. 34, no. 10, pp. 1886-1894. https://doi.org/10.1111/tri.13973

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T1 - Clinical implementation of coronary computed tomography angiography for routine detection of cardiac allograft vasculopathy in heart transplant patients

AU - Nous, Fay M.A.

AU - Roest, Stefan

AU - van Dijkman, Eva D.

AU - Attrach, Mohamed

AU - Caliskan, Kadir

AU - Brugts, Jasper J.

AU - Nieman, Koen

AU - Hirsch, Alexander

AU - Constantinescu, Alina A.

AU - Manintveld, Olivier C.

AU - Budde, Ricardo P.J.

N1 - Funding Information: Dr. Budde reports institutional research support to the Erasmus MC from Siemens Healthineers outside he submitted work. Dr. Nieman reports unrestricted institutional grants from Siemens Healthineers, Bayer, and HeartFlow Inc., outside the submitted work. All other authors have not to disclose. Publisher Copyright: © 2021 The Authors. Transplant International published by John Wiley & Sons Ltd on behalf of Steunstichting ESOT

PY - 2021/10

Y1 - 2021/10

N2 - Cardiac allograft vasculopathy (CAV) is an accelerated form of coronary artery disease that affects long-term outcomes in heart transplant (HTx) patients. We prospectively evaluated the feasibility of coronary computed tomography angiography (CCTA) for the detection of CAV during clinical implementation at our center. All consecutive HTx patients >4 years post-transplant were actively converted from myocardial perfusion imaging to CCTA for the annual assessment of CAV. Between February 2018 and May 2019, 129/172 (75%) HTx patients underwent a CCTA. Renal impairment (n = 21/43) was the most frequent reason for patients could not undergo CCTA. CCTA image quality was good–excellent in 118/129 (92%) patients, and the radiation dose was 2.1 (1.6–2.8) mSv. CCTA showed obstructive CAV in 19/129 (15%) patients. Thirteen (10%) patients underwent additional tests, of which 8 patients underwent coronary revascularization within 90 days of CCTA. After 1 year, 3 additional coronary angiograms were performed, resulting in one revascularization in a patient with known severe CAV who developed ventricular tachycardia. One myocardial infarction after coronary stenting and 2 non-cardiac deaths were observed. CCTA can be successfully implemented for routine detection of CAV with good image quality and low radiation dose. CCTA allows CAV evaluation with the limited need for additional invasive testing.

AB - Cardiac allograft vasculopathy (CAV) is an accelerated form of coronary artery disease that affects long-term outcomes in heart transplant (HTx) patients. We prospectively evaluated the feasibility of coronary computed tomography angiography (CCTA) for the detection of CAV during clinical implementation at our center. All consecutive HTx patients >4 years post-transplant were actively converted from myocardial perfusion imaging to CCTA for the annual assessment of CAV. Between February 2018 and May 2019, 129/172 (75%) HTx patients underwent a CCTA. Renal impairment (n = 21/43) was the most frequent reason for patients could not undergo CCTA. CCTA image quality was good–excellent in 118/129 (92%) patients, and the radiation dose was 2.1 (1.6–2.8) mSv. CCTA showed obstructive CAV in 19/129 (15%) patients. Thirteen (10%) patients underwent additional tests, of which 8 patients underwent coronary revascularization within 90 days of CCTA. After 1 year, 3 additional coronary angiograms were performed, resulting in one revascularization in a patient with known severe CAV who developed ventricular tachycardia. One myocardial infarction after coronary stenting and 2 non-cardiac deaths were observed. CCTA can be successfully implemented for routine detection of CAV with good image quality and low radiation dose. CCTA allows CAV evaluation with the limited need for additional invasive testing.

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JO - Transplant International

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Clinical implementation of coronary computed tomography angiography for routine detection of cardiac allograft vasculopathy in heart transplant patients

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