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(Circulation. 2000;101:2078.)
© 2000 American Heart Association, Inc.

Clinical Investigation and Reports

Electron-Beam Computed Tomography in the Assessment of Coronary Artery Disease After Heart Transplantation

Friedrich D. Knollmann, MD; Wolfgang Bocksch, MD; Susanne Spiegelsberger, MD; Roland Hetzer, MD; Roland Felix, MD; Manfred Hummel, MD

From the Department of Radiology, Charité, Virchow Hospital Campus, Humboldt University of Berlin (F.D.K., R.F.), and the Departments of Cardiology (W.B.) and Cardiothoracic and Vascular Surgery (S.S., R.H., M.H.), German Heart Institute, Berlin, Germany.

Correspondence to Friedrich D. Knollmann, MD, Strahlenklinik, Charité, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany. E-mail friedrich.knollmann{at}rz.hu-berlin.de

Background—Our aim was to compare the electron-beam CT (EBCT) features of coronary arteries in heart transplant recipients with those of biplane coronary angiography and intracoronary ultrasound (ICUS).

Methods and Results—We examined 112 heart transplant recipients (25 female; age, 17 to 69 years; median, 52 years) 1 to 153 months (median, 46 months) after surgery by EBCT to detect coronary artery calcifications. Calcifications were quantified by the Agatston scoring system. EBCT scores were compared with coronary angiography in all patients and ICUS of the left anterior descending coronary artery (LAD) in 100 patients. Coronary artery calcifications were found in 84 patients (75%). Angiographically, 16 patients displayed >50% coronary artery stenoses, all of whom had some degree of coronary artery calcification and only 1 of whom had a score of <55 (P<0.0001). With this threshold, EBCT had a sensitivity of 94%, a specificity of 79%, a positive predictive value of 43%, and a negative predictive value of 99% for detecting stenosis. ICUS confirmed the presence of calcified plaques in all patients with an LAD score >9. EBCT total calcium score was associated with the degree of intimal proliferation in that patients without ICUS features of allograft vasculopathy had a median score of 0 (25th percentile, 0; 75th percentile, 0), whereas patients with Stanford class IV vasculopathy had a median score of 41 (9 to 98, P<0.0001).

Conclusions—EBCT is a promising noninvasive test for the detection of coronary heart disease in cardiac transplant recipients.

Key Words: transplantation • coronary disease • tomography • calcium

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