Comparison of sixty-four-slice multidetector computed tomographic coronary angiography to coronary angiography with intravascular ultrasound for the detection of transplant vasculopathy.
Coronary allograft vasculopathy (CAV) is the most important limitation to long-term survival in adult heart transplant recipients and is difficult to detect without intravascular ultrasound (IVUS). We systematically evaluated the image quality of 64-slice multidetector computed tomographic (MDCT) coronary angiography in heart transplant recipients and tested the hypothesis that this modality is comparable to invasive coronary angiography with IVUS for the detection of CAV. Heart transplant recipients (n = 20) underwent invasive coronary angiography with IVUS and MDCT coronary angiography with a 64-slice scanner. Images were systematically analyzed for image quality and the presence of CAV. In addition, multidetector computed tomography and quantitative coronary angiography were used to measure lumen diameters at prespecified locations. Image quality analysis showed that, despite high mean heart rates (77 +/- 7 beats/min) and body mass index (29.5 +/- 5.3 kg/m(2)), 83% of coronary segments were graded as of excellent or good image quality. On average, 95 +/- 9% of the overall visualized length of the coronary arteries was imaged without motion artifacts, and the mean contrast-to-noise ratio was 11.3 +/- 4.6. Compared with IVUS, multidetector computed tomography had a sensitivity of 70%, specificity of 92%, positive predictive value of 89%, and negative predictive value of 77% for the detection of CAV. MDCT vessel diameter measurements correlated well with those obtained from quantitative coronary angiography (R(2) = 0.89). In conclusion, 64-slice multidetector computed tomography provides good to excellent image quality in heart transplant recipients and has moderate to excellent test characteristics for the detection of CAV. Further, MDCT measurements of lumen diameters correlated well with quantitative coronary angiography.
Gregory
Shawn A
SA
Cardiology Division, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
Ferencik
Maros
M
Achenbach
Stephan
S
Yeh
Robert W
RW
Hoffmann
Udo
U
Inglessis
Ignacio
I
Cury
Ricardo C
RC
Nieman
Koen
K
McNulty
Iris A
IA
Laffan
Josephine A
JA
Pomerantsev
Eugene V
EV
Brady
Thomas J
TJ
Semigran
Marc J
MJ
Jang
Ik-Kyung
IK
D015992:Body Mass Index; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000175:diagnosis*; D003331:Coronary Vessels / Q000473:pathology*; D005260:Female; D006339:Heart Rate; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014184:Transplantation, Homologous; D018084:Ultrasonography, Interventional