Electron-beam computed tomography in the assessment of coronary artery disease after heart transplantation

Background-Our aim was to compare the electron-beam CT (EBCT) features of c oronary arteries in heart transplant recipients with those of biplane coron ary angiography and intracoronary ultrasound (ICUS). Methods and Results-We examined 112 heart transplant recipients (25 female; age, 17 to 69 years; median, 53 years) 1 to 153 months (median, 46 months) after surgery by EBCT to detect coronary artery calcifications. Calcificat ions were quantified by the Agatston scoring system. EBCT scores were compa red with coronary angiography in all patients and ICUS of the left anterior descending coronary artery (LAD) in 100 patients. Coronary artery calcific ations were found in 83 patients (75%). Angiographically, 16 patients displ ayed >50% coronary artery stenoses, all of whom had some degree of coronary artery calcification and only 1 of whom had a score of <55 (P<0.0001). Wit h this threshold, EBCT had a sensitivity of 94%, a specificity of 79%, a po sitive predictive value of 43%, and a negative predictive value of 99% for detecting stenosis. ICUS confirmed the presence of calcified plaques in all patients with an LAD score >9. EBCT total calcium score was associated wit h the degree of intimal proliferation in that patients without ICUS feature s of allograft vasculopathy had a median score of 0 (25th percentile, 0; 75 th percentile, 0), whereas patients with Stanford class IV vasculopathy had a median score of 41 (9 to 98, P<0.0001). Conclusions-EBCT is a promising noninvasive test for the detection of corol lary heart disease in cardiac transplant recipients.