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CORONARY COMPUTED TOMOGRAPHY ANGIOGRAPHY FOR THE DETECTION OF CARDIAC ALLOGRAFT VASCULOPATHY: A META-ANALYSIS OF PROSPECTIVE TRIALS
A1163 JACC April 1, 2014 Volume 63, Issue 12
Non Invasive Imaging Coronary Computed Tomography Angiography for the Detection of Cardiac Allograft Vasculopathy: A Meta-Analysis of Prospective Trials Poster Contributions Hall C Sunday, March 30, 2014, 9:45 a.m.-10:30 a.m.
Session Title: Coronary and Peripheral Atherosclerosis Abstract Category: 18. Non Invasive Imaging: CT/Multimodality, Angiography, and Non-CT Angiography Presentation Number: 1176-71 Authors: Jorge Romero, Omar Wever-Pinzon, Anjani Golive, Iosif Kelesidis, Carlos Manrique, Stavros Drakos, Ileana Pina, Abdallah Kfoury, Josef Stehlik, Mario Garcia, Montefiore Medical Center, Bronx, NY, USA Background: Cardiac Allograft Vasculopathy (CAV) limits long term survival after heart transplantation. We evaluated the diagnostic accuracy of Coronary Computed Tomography Angiography (CCTA) for detecting CAV compared with Conventional Coronary Angiography (CCAG) alone or with Intravascular Ultrasound (IVUS). Methods: A systematic review of Medline, Cochrane, and Embase for all prospective trials was performed with standard meta-analysis approach for diagnostic test and bivariate analysis. Thirteen studies evaluating 615 patients (mean age 52 years, 83% males) and 9,481 segments were included. Results: Patient-based analyses comparing CCTA vs. CCAG for detection of any CAV (> luminal irregularities) and significant CAV (stenosis ≥ 50%), showed mean weighted sensitivities of 97% and 94%, specificities of 81% and 92%, negative predictive value (NPV) of 97% and 99%, positive predictive value (PPV) of 78% and 67%, and diagnostic accuracies of 88% and 94%, respectively. There was a strong trend towards improved sensitivity (97% vs. 91%, p=0.06) and NPV (99% vs. 97%, p=0.06) to detect significant CAV with 64-slice vs. 16-slice CCTA. Analysis of 64-slice CCTA vs. IVUS showed a mean weighted sensitivity and specificity of 81% and 75% to detect CAV (intimal thickening > 0.5 mm), whereas PPV and NPV were 93% and 50%, respectively. Conclusion: CCTA is a reliable noninvasive modality with excellent sensitivity, specificity and NPV. CCTA as a screening tool for CAV is feasible for heart transplant recipients.
Non Invasive Imaging Coronary Computed Tomography Angiography for the Detection of Cardiac Allograft Vasculopathy: A Meta-Analysis of Prospective Trials Poster Contributions Hall C Sunday, March 30, 2014, 9:45 a.m.-10:30 a.m.
Session Title: Coronary and Peripheral Atherosclerosis Abstract Category: 18. Non Invasive Imaging: CT/Multimodality, Angiography, and Non-CT Angiography Presentation Number: 1176-71 Authors: Jorge Romero, Omar Wever-Pinzon, Anjani Golive, Iosif Kelesidis, Carlos Manrique, Stavros Drakos, Ileana Pina, Abdallah Kfoury, Josef Stehlik, Mario Garcia, Montefiore Medical Center, Bronx, NY, USA Background: Cardiac Allograft Vasculopathy (CAV) limits long term survival after heart transplantation. We evaluated the diagnostic accuracy of Coronary Computed Tomography Angiography (CCTA) for detecting CAV compared with Conventional Coronary Angiography (CCAG) alone or with Intravascular Ultrasound (IVUS). Methods: A systematic review of Medline, Cochrane, and Embase for all prospective trials was performed with standard meta-analysis approach for diagnostic test and bivariate analysis. Thirteen studies evaluating 615 patients (mean age 52 years, 83% males) and 9,481 segments were included. Results: Patient-based analyses comparing CCTA vs. CCAG for detection of any CAV (> luminal irregularities) and significant CAV (stenosis ≥ 50%), showed mean weighted sensitivities of 97% and 94%, specificities of 81% and 92%, negative predictive value (NPV) of 97% and 99%, positive predictive value (PPV) of 78% and 67%, and diagnostic accuracies of 88% and 94%, respectively. There was a strong trend towards improved sensitivity (97% vs. 91%, p=0.06) and NPV (99% vs. 97%, p=0.06) to detect significant CAV with 64-slice vs. 16-slice CCTA. Analysis of 64-slice CCTA vs. IVUS showed a mean weighted sensitivity and specificity of 81% and 75% to detect CAV (intimal thickening > 0.5 mm), whereas PPV and NPV were 93% and 50%, respectively. Conclusion: CCTA is a reliable noninvasive modality with excellent sensitivity, specificity and NPV. CCTA as a screening tool for CAV is feasible for heart transplant recipients.