Evaluation of coronary allograft vasculopathy using multi-detector row computed tomography: a systematic review.
Razi Khan,Ik-Kyung Jang +1 more
TLDR
The high sensitivity and NPV of MDCT suggest that it may be a useful, noninvasive screening tool to rule out CAV.Abstract:
Summary Coronary allograft vasculopathy (CAV) is a significant cause of morbidity and mortality after cardiac transplantation and requires frequent surveillance with catheter-based coronary angiography (CCA). Multi-detector row computed tomography (MDCT) has been shown to be effective in assessing atherosclerosis in native coronary arteries. This article systematically reviews the literature to determine the accuracy of MDCT in CAVassessment. An English-language literature search was performed using EMBASE, OVID, PubMed, and Cochrane Library databases. Studies that directly compared MDCTwith CCA and/or IVUS for the detection of coronary artery stenosis or significant intimal thickening in cardiac transplant patients were analyzed. Data were pooled to obtain weighted sensitivities, specificities, and diagnostic accuracies. Negative and positive predictive values (NPV/PPV) were calculated. A total of seven studies with a sum of 272 patients were included in this review. There were three studies examining 16-slice MDCTand four studies looking at 64-slice MDCT in CAV. Using per-segment analysis, MDCTassessed between 91% and 96% of all coronary segments when evaluating for stenosis. Pooled estimates for sensitivity and specificity for MDCTranged from 82% to 89% and 89% to 99%, respectively, while NPV was 99%. Per-patient analysis revealed a sensitivity of 87—100% and NPV of 96—100%. PPV was less than 50% for 64slice MDCT in both per-segment and per-patient analysis. When compared with IVUS, MDCT had a sensitivity of 74—96% and specificity of 88—92% in assessment of intimal thickening. NPVand PPV were 80—81% and 84—98%, respectively. The high sensitivity and NPV of MDCTsuggest that it may be a useful, noninvasive screening tool to rule out CAV. # 2011 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.read more
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Book ChapterDOI
Intravascular Ultrasound in Graft
TL;DR: Although quantitative coronary angiography has been used to assess late lumen loss, IVUS provides more detailed and reliable information on the extent and distribution of intimal tissue, the presence of stent under expansion, and vascular remodeling after coronary artery bypass surgery.
Book ChapterDOI
Cardiac CT in the Setting of Heart Transplantation
Gorka Bastarrika,Gregorio Rábago +1 more
TL;DR: The results of most recent studies and meta-analysis suggest that CCTA could be considered as an alternative to conventional coronary angiography in the routine surveillance of heart transplant recipients, however, further research is warranted to determine the impact of this imaging technology in the management and clinical outcomes of this patient population.
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