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Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response.  Labels: BACKGROUND, METHODS, RESULTS. Meshes: Adult, Aged, Calcinosis, Coronary Angiography, Coronary Disease, Female, Heart Transplantation, Humans, Male, Middle Aged, Predictive Value of Tests, Tomography, X-Ray Computed, Young Adult.
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Are coronary calcifications detected by computed tomography markers of cardiac allograft vasculopathy? Context: 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. 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. 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%.
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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. Final Decision: no