Comprehensive morphologic and functional imaging of heart transplant patients: first experience with dynamic perfusion CT
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We aimed to assess the diagnostic performance of a combined protocol with coronary computed tomography angiography (CCTA) and stress CT perfusion imaging (CTP) in heart transplant patients for comprehensive morphological and functional imaging.
In this prospective study, 13 patients undergoing routine follow-up 8±6 years after heart transplantation underwent CCTA and dynamic adenosine stress CTP using a third-generation dual-source CT scanner, cardiac magnetic resonance (MR) adenosine stress perfusion imaging at 1.5 T, and catheter coronary angiography. In CCTA stenoses >50% luminal diameter narrowing were noted. Myocardial perfusion deficits were documented in CTP and MR. Quantitative myocardial blood flow (MBF) was calculated with CTP. Left ventricular ejection fraction was determined on cardiac MR cine images. Radiation doses of CT were determined.
One of the 13 patients had to be excluded because of severe motion artifacts. CCTA identified three patients with stenosis >50%, which were confirmed with catheter coronary angiography. CTP showed four patients with stress-induced myocardial hypoperfusion, which were confirmed by MR stress perfusion imaging. Quantitative analysis of global MBF showed lower mean values as compared to known reference values (MBF under stress 125.5 ± 34.5 ml/100 ml/min). Average left ventricular ejection fraction was preserved (56 ± 5%).
In heart transplant patients, a comprehensive CT protocol for the assessment of morphology and function including CCTA and CTP showed good concordance to results from MR perfusion imaging and catheter coronary angiography.
• Stress CT perfusion imaging enables the detection of myocardial ischemia
• CT myocardial perfusion imaging can be combined with coronary computed tomography angiography
• Combining perfusion and coronary CT imaging is accurate in heart transplant patients
• CT myocardial perfusion imaging can be performed at a reasonable radiation dose
KeywordsCoronary angiography Multidetector-row computed tomography Magnetic resonance imaging Myocardial perfusion imaging Transplantation
Beats per minute
Cardiac allograft vasculopathy
Coronary computed tomography angiography
Computed tomography perfusion
Estimated glomerular filtration rate
International society of heart and lung transplantation
Myocardial blood flow
Mechanistic target of rapamycin
The authors state that this work has not received any funding.
Compliance with ethical standards
The scientific guarantor of this publication is Hatem Alkadhi.
Conflict of interest
The authors of this manuscript declare relationships with the following companies: Dr. Ernst Klotz, PhD, is physicist of Siemens Healthcare with an expertise in CT perfusion imaging.
Statistics and biometry
One of the authors has significant statistical expertise.
Written informed consent was obtained from all subjects (patients) in this study.
Institutional Review Board approval was obtained.
• case-control study
• performed at one institution
- 1.Chambers DC, Yusen RD, Cherikh WS et al (2017) The Registry of the International Society for Heart and Lung Transplantation: Thirty-fourth Adult Lung And Heart-Lung Transplantation Report-2017; Focus Theme: Allograft ischemic time. J Heart Lung Transplant. https://doi.org/10.1016/j.healun.2017.07.016 CrossRefGoogle Scholar
- 14.Ponikowski P, Voors AA, Anker SD et al (2016) 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail 18:891–975CrossRefGoogle Scholar
- 15.European Society of C, European Heart Rhythm A, Brignole M et al (2013) 2013 ESC guidelines on cardiac pacing and cardiac resynchronization therapy: the task force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC). Developed in collaboration with the European Heart Rhythm Association (EHRA). Europace 15:1070–1118CrossRefGoogle Scholar
- 21.Cerqueira MD, Weissman NJ, Dilsizian V et al (2002) Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart. A statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association. Circulation 105:539–542CrossRefGoogle Scholar
- 22.Rossi A, Wragg A, Klotz E et al (2017) Dynamic computed tomography myocardial perfusion imaging: comparison of clinical analysis methods for the detection of vessel-specific ischemia. Circ Cardiovasc Imaging. https://doi.org/10.1161/CIRCIMAGING.116.005505
- 24.Manka R, Wissmann L, Gebker R et al (2015) Multicenter evaluation of dynamic three-dimensional magnetic resonance myocardial perfusion imaging for the detection of coronary artery disease defined by fractional flow reserve. Circ Cardiovasc Imaging 8Google Scholar
- 36.Pampaloni MH, Shrestha UM, Sciammarella M, Seo Y, Gullberg GT, Botvinick EH (2017) Noninvasive PET quantitative myocardial blood flow with regadenoson for assessing cardiac allograft vasculopathy in orthotopic heart transplantation patients. J Nucl Cardiol. https://doi.org/10.1007/s12350-016-0761-3 CrossRefGoogle Scholar