Learning objectives
After review of this e-poster,
the reader will be familiar with:
The who,
what,
where,
when and why of Cardiac Allograft Vasculopathy (CAV);who does it affect?,what is it?,when does it occur?,where in the coronary arteries are affected?,and why.
The implications of CAV,
in terms of morbidity and mortality.
The benefits and limitations of CCTA.
The dose implication of CCTA.
The appearances of CAV on CCTA.
Background
Cardiac allograft vasculopathy (CAV) is an accelerated form of coronary artery disease that affects vessels of transplanted hearts,
and is characterised by diffuse intimal hyperplasia and luminal narrowing in the allograft arteries,
epicardial vessels and microcirculation1.
Post-transplant CAV occurs in up to 47% of patients depending on the time since transplant (8% within 1 year,
30% within 5 years,
47% within ten years) according to theInternational Society of Heart and Lung Transplantation registry(ISHLT)3.
CAVis a significant cause of mortality.
The proportion of deaths caused by...
Findings and procedure details
CAV typically affects themiddle segments,
distal segments,
and side branches of epicardial arteries4.
The major characteristics are diffuse concentric atheromatosis and homogenous luminal thickening which causesconcentric narrowing of the vessel lumen rather than focal/eccentric luminal constrictionin typical coronary artery disease.
In CAV there isadventitial fibrosis,soft plaqueand rarely calcification5.
ClassicCAD is typified by variable stenosis,
eccentric and heterogenous plaques,
remodelling and calcification.
Conclusion
CCTA is a sensitive,
non-invasivescreening test and isless costly and less resource intensive than formal angiography for detecting CAV.
CCTA findings that suggest CAV include diffuse concentric atheromatosis and homogenous luminal thickening,
concentric narrowing of the vessel lumen,soft plaqueand rarely calcification5.
Personal information
A.
N.
Murphy; Radiology resident.
B.
Buckley; Radiology resident.
J.
MURRAY; Radiology Consultant.
References
1.Bogot NR,
Durst R,
Shaham D,
Admon D.
Cardiac CT of the transplanted heart: indications,
technique,
appearance,
and complications.
Radiographics.
2007;27(5):1297-309.
2.Lund LH,
Khush KK,
Cherikh WS,
Goldfarb S,
Kucheryavaya AY,
Levvey BJ,
et al.
The Registry of the International Society for Heart and Lung Transplantation: Thirty-fourth Adult Heart Transplantation Report-2017; Focus Theme: Allograft ischemic time.
J Heart Lung Transplant.
2017;36(10):1037-46.
3.Mittal TK,
Panicker MG,
Mitchell AG,
Banner NR.
Cardiac allograft vasculopathy after heart transplantation: electrocardiographically gated cardiac CT angiography for assessment.
Radiology.
2013;268(2):374-81.
4.Vecchiati...
