Quality and diagnostic performance of coronary computed tomography angiogram (CCTA): A comparison between pre-liver and pre-kidney transplant patients

Rachael R Kirkbride; Emily Larkin; Mark K Tuttle; Michael D Nicholson; Brian G Jiang; Rokas Liubauskas; Jason D Matos; Michael Gavin; Diana E Litmanovich

doi:10.1016/j.ejrad.2021.109886

Quality and diagnostic performance of coronary computed tomography angiogram (CCTA): A comparison between pre-liver and pre-kidney transplant patients

Eur J Radiol. 2021 Oct:143:109886. doi: 10.1016/j.ejrad.2021.109886. Epub 2021 Jul 31.

Authors

Rachael R Kirkbride¹, Emily Larkin¹, Mark K Tuttle², Michael D Nicholson³, Brian G Jiang¹, Rokas Liubauskas¹, Jason D Matos², Michael Gavin², Diana E Litmanovich⁴

Affiliations

¹ Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
² Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
³ Department of Data Science, Dana-Farber Cancer Institute, Boston, MA, USA; Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Stem Cell and Regenerative Biology, Harvard University, Cambridge, MA, USA.
⁴ Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. Electronic address: dlitmano@bidmc.harvard.edu.

PMID: 34412010
DOI: 10.1016/j.ejrad.2021.109886

Abstract

Purpose: Assess and compare the quality and diagnostic performance of CCTA between pre-liver and pre-kidney transplant patients, and gauge impact of CCTA on ICA requirements.

Methods: Patients without known coronary artery disease (CAD) were selected for CCTA if considered high-risk or after abnormal stress testing. All pre-liver and pre-kidney CCTAs between March 2018 and August 2020 were retrospectively included. CCTA quality was qualitatively graded as excellent/good/fair/poor, and CAD graded as < or ≥50% stenosis. Heart rate, coronary artery calcium (CAC) scores, and fractional flow reserve CT (FFR_CT) results were collected. CAD stenosis was graded on invasive coronary angiogram (ICA) images, with ≥50% stenosis defined as significant.

Results: 162 pre-transplant patients (91 pre-liver, 71 pre-kidney). Pre-kidney patients had poorer CCTA quality (p = 0.04) and higher heart rate (median: 65 bpm vs 60 bpm, p < 0.001). Out of 147 diagnostic CCTAs (pre-liver: 84, pre-kidney: 63), 73 (49.7%) had a ≥50% stenosis (pre-liver: 38 (45.2%), pre-kidney:35 (55.6%)). 12/38 (31.6%) had a significantly reduced FFR_CT, and 19/53 (35.8%) had ≥50% stenosis on ICA. Among patients whose CCTA was diagnostic and had ICA, stenosis severity was concordant in 10/23 (43.5%) pre-liver and 10/25 (40%) pre-kidney patients. All discordant cases had stenosis 'over-called' on CCTA.

Conclusion: Diagnostic-quality CCTAs in high-risk pre-transplant patients are achievable and can greatly reduce ICA requirements by excluding significant CAD. CCTA quality is poorer in pre-kidney transplant patients compared to pre-liver, possibly due to higher heart rate.

Keywords: Coronary artery disease; Coronary computed tomography angiogram; Fractional flow reserve computed tomography; Invasive coronary angiogram; Pre-kidney transplant; Pre-liver transplant.

MeSH terms

Computed Tomography Angiography
Coronary Angiography
Coronary Artery Disease* / diagnostic imaging
Coronary Stenosis*
Fractional Flow Reserve, Myocardial*
Humans
Kidney Transplantation*
Liver
Predictive Value of Tests
Retrospective Studies
Tomography, X-Ray Computed