Abstract Background Coronary computed tomography angiography (CCTA) is emerging as a valuable tool for non-invasive surveillance of cardiac allograft vasculopathy (CAV) in patients with heart transplant (HTx). Purpose We assessed the diagnostic performance of a comprehensive CCTA-based approach compared to the invasive reference including invasive coronary angiography (ICA), intravascular ultrasound (IVUS), and fractional flow reserve (FFR) for detecting CAV. Methods Multicenter prospective study including 37 HTx patients undergoing CCTA, ICA, IVUS, and FFR. The comprehensive CCTA-based approach included quantitative and qualitative plaque analysis and functional assessment by CCTA-derived fractional flow reserve (FFRCT). CAV was diagnosed based on ICA (ISHLT criteria) and IVUS. Univariable logistic regression analysis was performed to test CCTA-derived predictors of CAV. The area under the curve (AUC) and accuracy indicators were calculated to test the performance and best cut-offs of CCTA predictors of CAV. Results The median interval between CCTA and HTx was 5 years. Among the 37 recipients, 23 (62.2%) were diagnosed with CAV. The integration of diameter stenosis and plaque morphology (including plaque burden at minimum lumen area 42% and percent atheroma volume 23%) at CCTA yielded the highest diagnostic performance (accuracy: 84%, sensitivity: 83%, specificity: 86%). The integration of ∆FFRCT trans-vessel gradient led to increased sensitivity, albeit with decreased specificity and overall accuracy. The non-invasive approach was associated with lower contrast and radiation dose, compared to the invasive approach. Conclusions A non-invasive strategy based on CCTA is accurate for managing HTx patients. CCTA might be considered the preferred imaging modality for annual CAV surveillance after the first year post-HTx.Diagnostic accuracy of the models Summary of the main findings
Belmonte et al. (2025) studied this question.