Clin Res Cardiol 100, Suppl 1, April 2011

P1349 - Coronary Calcifications as detected by Dual-Source Computed Tomography are not a Marker of Cardiac Allograft Vasculopathy in Patients after Heart Transplantation
 
F. von Ziegler1, A. Knez2, M. Greif1, J. Rümmler1, B. Reichart3, I. Kaczmarek3, C. Becker4, G. Steinbeck1, A. Becker1
 
1Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Campus Großhadern, München; 2Innere Medizin, Krankenhaus Weilheim, Weilheim; 3Herzchirurgische Klinik und Poliklinik, Klinikum der Universität München, Campus Großhadern, München; 4Institut für Klinische Radiologie, Klinikum der Universität München, Campus Großhadern, München;
 
Background: Despite major improvements in immunosuppressive therapy regimes over the last decade, cardiac allograft vasculopathy (CAV) still remains a leading cause of morbidity and mortality after heart transplantation (HTX). High negative predictive values of cardiac computed tomography calcium scoring (CS) suggest a potential strength of this non-invasive modality in ruling out coronary heart disease (CHD) based on traditional coronary atherosclerosis. According to initial studies, CS also seems to be a non-invasive marker of CAV, and thus an auspicious diagnostic tool for clinical care of heart transplant recipients. This study sought to evaluate the clinical feasibility of dual-source computed tomography calcium scoring (DSCTCS) for the detection of CAV in particular as follow-up examination after HTX.
Methods: An overall of 176 patients (139 male; 37 female; mean age: 50.0±12.4 years; range:19-75 years) underwent DSCTCS (Definition, Siemens Medical Solutions, Forchheim, Germany) 1±2 days before annual routine invasive coronary angiography (ICA). Mean post-transplant time was 73.3±50.5 months ranging from 11 to 231 months. The results of DSCTCS were compared to the results of invasive coronary angiography (ICA). To account for the known imprecision of ICA to detect early intimal vessel wall changes based on CAV, the following definition was chosen: no significant CAV was assumed if no angiographic lesion was detected. Significant CAV was defined as any coronary lesion detected by ICA
Results: In 106 patients (60.2%; 87 male; 19 female; mean age: 51.1±12.7 years; range: 22-71 years) 78.2±51.6 months after heart transplantation procedure, coronary calcium deposits were detected. Mean overall coronary calcium volume score was calculated as 24.0±50.3 (range: 0-385). In 70 patients (39.8%; 52 male; 18 female; mean age: 48.3±11.8 years; range: 19-75 years, 66.0±48.1 months after heart transplantation) coronary calcium could be excluded. According to the results of ICA, in an overall 83 patients (47.2%; 68 male; 15 female; mean age: 47.8±12.6 years; range: 19-71 years) CAV as defined above, could be excluded. In 93 patients (52.8%; 71 male; 22 female; mean age 52.4±11.9 years; range: 24-75 years) signs of CAV were detected. An overall of 13 patients needed stent implantation procedures after diagnostic ICA. Adding the results of DSCT calcium scoring no statistically significant difference in patients without CAV (16.8±29.7; range: 0-190) and patients with detected CAV (32.1±65.5; range 0-385) could be observed (p= 0.119). Moreover in 4/13 (30.8%) patients with server CAV needing intervention after diagnostic ICA, coronary calcium deposits were excluded. Sensitivity and specificity for detection of CAV using a CS threshold of >0 was calculated as 69.9%, and 48.4%, respectively. Negative predictive value and positive predictive value was 64.3%, and 54.7%, respectively. Diagnostic accuracy for CAV detection was calculated as 58.5%.
Conclusion: According to our results, DSCTCS is not a valuable non-invasive diagnostic test for the detection of CAV after HTX. Diagnostic performance evaluation revealed insufficiency to recommend this modality. We hypothesize that coronary calcifications represent pre-existing or independently developing de-novo traditional coronary atherosclerosis rather than CAV.
 
Clin Res Cardiol 100, Suppl 1, April 2011
Zitierung mit Vortrags- oder Posternummer s.o.
DOI 10.1007/s00392-011-1100-y

http://www.abstractserver.de/dgk2011/ft/abstracts/P1349.htm