Quantitative CT assessment identifies more heart transplanted patients with progressive coronary wall thickening than standard clinical read.
BACKGROUND
We sought to compare quantitative coronary CT angiography (CTA) assessment versus standard clinical reading to identify heart transplanted (HTX) patients with progressive coronary wall thickening.


METHODS
35 patients (23 males, age 58 [IQR: 50;61] years) underwent 256-slice coronary CTA at one year and two years after HTX to rule out cardiac allograft vasculopathy (CAV). In addition to the standard clinical read, we quantified total vessel wall volume in all coronaries up to 2-mm luminal diameter. Fixed threshold settings were used to assess calcified (>350 HU) and non-calcified vessel wall components with high- (131-350 HU), intermediate- (75-130 HU) and low-attenuation (<75 HU).


RESULTS
Total lumen volume did not change between baseline and follow-up studies (p = 0.59). Total vessel wall volume showed significant increase (464 [IQR: 338; 570] vs. 563 [IQR: 345; 717] mm3, p < 0.001). The volume of high-, intermediate and low-attenuation non-calcified wall components showed progression (332 [IQR: 217;425] vs. 385 [IQR: 238;489], 40 [IQR: 12;48] vs. 59 [IQR: 16;83] and 18 [IQR: 4;21] vs. 46 [IQR: 6;41] mm3, respectively, p < 0.05 all), while calcified volume did not change between baseline and follow-up CTAs (72 [IQR: 16;127] vs. 72 [IQR: 29;102] mm3, p = 0.73). Quantitative analysis identified more patients with progressive coronary wall thickening (≥10% cut-off) than standard clinical read (11 vs. 22, p = 0.01).


CONCLUSION
Quantitative coronary wall assessment is feasible with coronary CTA in HTX patients. Coronary wall thickening within the first two years after HTX is mainly attributable to non-calcified lesion components and might be an early sign of CAV.
['Károlyi|Mihály|M|', 'Kolossváry|Márton|M|', 'Bartykowszki|Andrea|A|', 'Kocsmár|Ildikó|I|', 'Szilveszter|Bálint|B|', 'Karády|Júlia|J|', 'Merkely|Béla|B|', 'Maurovich-Horvat|Pál|P|']
D000072226:Computed Tomography Angiography D017023:Coronary Angiography D003324:Coronary Artery Disease D003331:Coronary Vessels D005240:Feasibility Studies D005260:Female D016027:Heart Transplantation D006801:Humans D008297:Male D008875:Middle Aged D061330:Multidetector Computed Tomography D011237:Predictive Value of Tests D012189:Retrospective Studies D016896:Treatment Outcome
Heart transplantation Coronary CT angiography Cardiac allograft vasculopathy Coronary artery disease Coronary vessels