Added prognostic value of visually estimated coronary artery calcium among heart transplant recipients.

Clerkin, Kevin J; Sewanan, Lorenzo; Griffin, Jan M; DeFilippis, Ersilia M; Peng, Boyu; Chernovolenko, Margarita; Harris, Erin; Prasad, Nikil; Colombo, Paolo C; Yuzefpolskaya, Melana; Fried, Justin; Raikhelkar, Jayant; Topkara, Veli K; Castillo, Michelle; Lam, Elaine Y; Latif, Farhana; Takeda, Koji; Uriel, Nir; Sayer, Gabriel; Einstein, Andrew J

Clerkin, Kevin J; Sewanan, Lorenzo; Griffin, Jan M; DeFilippis, Ersilia M; Peng, Boyu; Chernovolenko, Margarita; Harris, Erin; Prasad, Nikil; Colombo, Paolo C; Yuzefpolskaya, Melana; Fried, Justin; Raikhelkar, Jayant; Topkara, Veli K; Castillo, Michelle; Lam, Elaine Y; Latif, Farhana; Takeda, Koji; Uriel, Nir; Sayer, Gabriel; Einstein, Andrew J.

Afiliação

Clerkin KJ; Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York. Electronic address: kjc2142@cumc.columbia.edu.
Sewanan L; Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York.
Griffin JM; Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina.
DeFilippis EM; Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York.
Peng B; Department of Radiology, Columbia University Irving Medical Center, New York, New York.
Chernovolenko M; Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York.
Harris E; Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York.
Prasad N; Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York.
Colombo PC; Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York.
Yuzefpolskaya M; Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York.
Fried J; Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York.
Raikhelkar J; Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York.
Topkara VK; Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York.
Castillo M; Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York.
Lam EY; Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York.
Latif F; Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York.
Takeda K; Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Columbia University Medical Center, New York, New York.
Uriel N; Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York.
Sayer G; Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York.
Einstein AJ; Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York.

J Heart Lung Transplant ; 2024 Aug 07.

Article em En | MEDLINE | ID: mdl-39122222

ABSTRACT

ABSTRACT

BACKGROUND:

Cardiac hybrid positron emission tomography/computed tomography (PET/CT) has become a valid screening modality for cardiac allograft vasculopathy (CAV) following heart transplantation (HT). Visually estimated coronary artery calcium (VECAC) can be quantified from CT images obtained as part of PET/CT and has been shown to be associated with adverse cardiovascular outcomes in coronary artery disease. We investigated the prognostic value of VECAC following HT.

METHODS:

A retrospective analysis of 430 consecutive adult HT patients who underwent 13N-ammonia cardiac PET/CT from 2016 to 2019 with follow-up through October 15, 2022, was performed. VECAC categories included VECAC 0, VECAC 1-9, VECAC 10-99, and VECAC 100+. The association between VECAC categories and outcomes was assessed using univariable and multivariable proportional hazards regression. The primary outcome was death/retransplantation.

RESULTS:

The cohort was 73% male, 33% had diabetes, 67% had estimated glomerular filtration rate <60 ml/min, median age was 61 years, and median time since HT was 7.5 years. VECAC alone was insufficiently sensitive to screen for CAV. During a median follow-up of 4.2 years ninety patients experienced death or retransplantation. Compared with those with VECAC 0, patients VECAC 10-99 (HR 2.25, 95% CI 1.23-4.14, p = 0.009) and VECAC 100+ (HR 3.42, 95% CI 1.96-5.99, p < 0.001) experienced an increased risk of death/retransplantation. The association was similar for cardiovascular death and cardiovascular hospitalization. After adjusting for other predictors of death/retransplantation, VECAC 10-99 (VECAC 10-99 aHR 1.95, 95% CI 1.03-3.71 p = 0.04) and VECAC 100+ (VECAC 100+ aHR 2.33, 95% CI 1.17-4.63, p = 0.02) remained independently associated with death/retransplantation.