title: Coronary calcifications detected by computed tomography are not markers of cardiac allograft vasculopathy.
abstract: BACKGROUND
  Cardiac allograft vasculopathy (CAV) still limits survival after heart transplantation. Currently available noninvasive tests are of inferior value to detect CAV, and thus invasive coronary angiography (ICA) is frequently performed. Cardiac dual-source computed tomography calcium scoring (DSCTCS) offers the possibility to detect coronary calcifications, which might serve as a noninvasive marker of CAV. This study sought to evaluate its clinical feasibility.
  
  
  METHODS
  One hundred sixty-one patients (130 men; 31 women; mean age: 50.5±12.1 years) underwent DSCTCS 1±2 days before annual routine ICA. Mean posttransplant time was 73.7±49.6 months. The results of DSCTCS were compared with ICA.
  
  
  RESULTS
  In 100 patients (85 men; 15 women; mean age: 51.5±12.3 years), coronary calcifications were detected, and in 61 patients (45 men; 16 women; mean age: 49.0±11.7 years), coronary calcifications were excluded. ICA excluded CAV in 82 patients (63 men; 19 women; mean age: 48.6±11.9 years). In 79 patients (67 men; 12 women; mean age: 52.5±12.2 years), CAV was detected of whom 11 patients needed stent implantation. No statistically significant difference of DSCTCS in patients without (17.2±29.5; range: 0-190) and with CAV (33.4±66.8; range: 0-385) was observed (P=0.133). Moreover, 4 of 11 (36.4%) severely diseased patients had a calcium score of zero. Sensitivity, specificity, negative predictive value, and positive predictive value for CAV detection (calcium score threshold >0) was calculated as 72.2%, 47.6%, 47.7%, and 57.0%, respectively. Diagnostic accuracy was 59.6%.
  
  
  CONCLUSIONS
  DSCTCS is not a valuable noninvasive modality for CAV detection and thus not recommended in clinical practice. Moreover, we hypothesize that it represents preexisting or de novo traditional coronary atherosclerosis than CAV.
authors.affiliation: Department of Cardiology, Ludwig-Maximilians University, Grosshadern Campus, Munich, Germany. franz.ziegler@med.uni-muenchen.de
authors.forename: Franz
authors.initials: F
authors.lastname: von Ziegler
authors.forename: Ingo
authors.initials: I
authors.lastname: Kaczmarek
authors.forename: Andreas
authors.initials: A
authors.lastname: Knez
authors.forename: Martin
authors.initials: M
authors.lastname: Greif
authors.forename: Janine
authors.initials: J
authors.lastname: Rümmler
authors.forename: Bruno
authors.initials: B
authors.lastname: Meiser
authors.forename: Bruno
authors.initials: B
authors.lastname: Reichart
authors.forename: Christoph
authors.initials: C
authors.lastname: Becker
authors.forename: Gerhard
authors.initials: G
authors.lastname: Steinbeck
authors.forename: Alexander
authors.initials: A
authors.lastname: Becker
mesh_terms: D000328:Adult; D000368:Aged; D002114:Calcinosis / Q000175:diagnosis / Q000000981:diagnostic imaging*; D017023:Coronary Angiography; D003327:Coronary Disease / Q000175:diagnosis / Q000000981:diagnostic imaging*; D005260:Female; D016027:Heart Transplantation / Q000009:adverse effects* / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D014057:Tomography, X-Ray Computed / Q000379:methods*; D055815:Young Adult