Redefining CAV surveillance strategies: Benefits of CCTA vs. ICA

J Cardiovasc Comput Tomogr. 2025 Jan-Feb;19(1):162-168. doi: 10.1016/j.jcct.2024.07.004. Epub 2024 Jul 20.

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.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Computed Tomography Angiography* / adverse effects
  • Computed Tomography Angiography* / economics
  • Coronary Angiography* / adverse effects
  • Coronary Angiography* / economics
  • Coronary Angiography* / methods
  • Coronary Artery Disease* / diagnostic imaging
  • Coronary Artery Disease* / economics
  • Coronary Artery Disease* / etiology
  • Coronary Artery Disease* / therapy
  • Cost-Benefit Analysis
  • Female
  • Heart Transplantation* / adverse effects
  • Heart Transplantation* / economics
  • Hospital Costs
  • Humans
  • Length of Stay
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Retrospective Studies
  • Time Factors
  • Treatment Outcome