Coronary artery calcium predicts worse outcome after heart transplantation

Heart transplant recipients have worse prognosis if a CT scan reveals coronary artery calium several years after the transplantation, according to the PhD thesis of Anne Günther.


MAIN RESULTS:

  1. Elevated levels of inflammatory markers in the circulation is associated with advanced cardiac allograft vasculopathy after heart transplantation. Inflammation is also associated with an increased intimal inflammatory component, indicating more vulnerable lesions.
  2. Heart transplant recipients with the presence of coronary artery calcium assessed by computed tomography have worse long-term outcome than patients without coronary artery calcium.
  3. Computed tomography compares well to coronary angiography in the assessment of coronary artery stenosis following heart transplantation.

THESIS DEFENCE:

Thesis: Imaging in the diagnosis and prediction of allograft vasculopathy after heart transplantation
Candidate: Anne Günther
Time: October 12, 2017 at 12:15
Place: Oslo University Hospital Rikshospitalet: The Large Auditorium
Link to university website (in Norwegian)


SUMMARY:

(1) Routine measurements of C-reactive protein (CRP), VCAM-1 and neopterin could possibly identify heart transplant recipients at high risk of coronary artery disease. Higher levels of each of the inflammatory markers were independently associated with maximal intimal thickness of the coronary arteries. CRP and VCAM-1 were also associated with increased inflammation of the intima, indicating more vulnerable lesions. 101 patients were included, and cardiac allograft vasculopathy was assessed by intravascular ultrasound.

(2) Heart transplant recipients with coronary artery calcium assessed by computed tomography up to ten years after transplantation have 80 % increased risk of an adverse event (death, allograft loss or a severe cardiovascular event) compared to patients where calcium is absent. Absence of coronary artery calcium on CT could be used to exclude moderate or severe cardiac allograft vasculopathy and significant coronary artery stenosis.

133 heart transplant patients were included in these analyses. Coronary artery calcium was detected in more than half of the patients.

(3) Compared to invasive coronary angiography, computed tomography showed good agreement in the assessment of coronary artery stenosis. However, maximal intimal thickness assessed by CT only showed moderate agreement with measurements done with intravascular ultrasound.


REFERENCES:

(1) Arora, S., Günther, A., Wennerblom, B., Ueland, T., Andreassen, A. K., Gude, E., Endresen, K., Geiran, O., Wilhelmsen, N., Andersen, R., Aukrust, P., & Gullestad, L. (2010). Systemic markers of inflammation are associated with cardiac allograft vasculopathy and an increased intimal inflammatory componentAmerican Journal of Transplantation10(6), 1428-1436.

(2) Günther, A., Andersen, R., Gude, E., Jakobsen, J., Edvardsen, T., Sandvik, L., Abildgaard, A., Aaberge, L., & Gullestad, L. (2017). The predictive value of coronary artery calcium detected by computed tomography in a prospective study on cardiac allograft vasculopathy in heart transplant patientsTransplant International.

(3) To be published.