Redefining CAV surveillance strategies: Benefits of CCTA vs. ICA

Valeria Pergola; Nicola Pradegan; Elena Cozza; Dan Alexandru Cozac; Irene Cao; Chiara Tessari; Maria Teresa Savo; Giuseppe Toscano; Annalisa Angelini; Vincenzo Tarzia; Giuseppe Tarantini; Francesco Tona; Giorgio De Conti; Sabino Iliceto; Gino Gerosa; Raffaella Motta

doi:10.1016/j.jcct.2024.07.004

Redefining CAV surveillance strategies: Benefits of CCTA vs. ICA

J Cardiovasc Comput Tomogr. 2024 Jul 20:S1934-5925(24)00392-7. doi: 10.1016/j.jcct.2024.07.004. Online ahead of print.

Authors

Valeria Pergola¹, Nicola Pradegan², Elena Cozza¹, Dan Alexandru Cozac³, Irene Cao⁴, Chiara Tessari⁴, Maria Teresa Savo¹, Giuseppe Toscano¹, Annalisa Angelini⁵, Vincenzo Tarzia⁴, Giuseppe Tarantini¹, Francesco Tona¹, Giorgio De Conti⁶, Sabino Iliceto¹, Gino Gerosa⁴, Raffaella Motta⁷

Affiliations

¹ Cardiology Unit, Cardio-thoraco-vascular and Public Health Department, Padova University Hospital, Padova, Italy.
² Cardiac Surgery Unit, Cardio-thoraco-vascular and Public Health Department, Padova University Hospital, Padova, Italy. Electronic address: [email protected].
³ Cardiology Unit, Cardio-thoraco-vascular and Public Health Department, Padova University Hospital, Padova, Italy; Emergency Institute for Cardiovascular Diseases and Transplantation of Targu Mures, Romania.
⁴ Cardiac Surgery Unit, Cardio-thoraco-vascular and Public Health Department, Padova University Hospital, Padova, Italy.
⁵ Cardiovascular Pathology, Cardio-thoraco-vascular and Public Health Department, Padova University Hospital, Padova, Italy.
⁶ Radiology Unit, Azienda Ospedale-Università Padova, 35128, Padova, Italy.
⁷ Department of Cardiac, Thoracic, Vascular Sciences and Public Health-DCTV, University of Padova, 35128, Padova, Italy.

PMID: 39034189
DOI: 10.1016/j.jcct.2024.07.004

Abstract

Background: Cardiac allograft vasculopathy (CAV) assessment post-heart transplantation (HT) typically relies on invasive coronary angiography (ICA). However, cardiac computed tomography angiography (CCTA) is emerging as a promising alternative due to its potential benefits in economic, safety, and logistical aspects. This study aimed to evaluate the impact of a CCTA program on these aspects in CAV surveillance post-HT.

Methods: A retrospective single-center study was conducted between March 2021 and February 2023, involving HT patients who underwent either CCTA or ICA.

Results: Among 260 patients undergoing CAV surveillance, 115 (44.2%) patients underwent CCTA, and 145 (55.8%) patients underwent ICA. The CCTA group showed incurred lower overall costs (p < 0.0001) and shorter hospitalization times (p < 0.0001) compared to the ICA group. In terms of safety, CCTA surveillance required significantly lower contrast volumes (p < 0.0001) and lower effective doses (p = 0.03).

Conclusion: CCTA emerges as a safe and cost-effective non-invasive alternative for CAV surveillance post-HT, outperforming ICA in terms of safety, logistical aspects, and economic burden.

Keywords: Business in CT; Cardiac allograft vasculopathy; Cardiac computed tomography angiography; Financial aspect of CT; Heart transplantation; Radiation exposure.