SPC365

The impact on therapeutic approach after coronary computed tomography in a heart transplant patient population

Session: Comunicações Orais - Sessão 14 - Transplante cardíaco
Speaker: Ana Amador

Congress: CPC 2023
Topic: H. Interventional Cardiology and Cardiovascular Surgery
Theme: 26. Cardiovascular Surgery
Subtheme: 26.8 Cardiovascular Surgery - Transplantation
Session Type: Comunicações Orais
FP Number: ---
Authors: Ana Amador; João Calvão; Catarina Martins da Costa; André Cabrita; Catarina Marques; Ana Pinho; Luís Santos; Cátia Oliveira; Mariana Vasconcelos; Sandra Amorim; Filipe Macedo
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">Background.</span></span></strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"> Although coronary angiography&nbsp;(CA) remains the goldstandard for coronary allograft vasculopathy (CAV) screening, coronary computed tomography (CCT) has been used as non-invasive alternative. There is sparse data regarding how the CCT findings impact subsequent medical approach.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">Methods.</span></span></strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"> From January 2021 to April 2022, we prospectively included heart transplant (HT) recipients who performed CCT for CAV detection at a university hospital centre. Clinical, CCT and CA&nbsp;data were collected. </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">Results.</span></span></strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"> We included 38 patients (pts), 23 (60.5%) men with mean age of 58&plusmn;14 years. The main cause of transplantation was familial dilated cardiomyopathy (42.1%), followed by ischemic cardiopathy (31.6%). Median graft duration was 10 years (IQR 9) and 65.8% had previous rejection. At CCT time, 97.4% of pts had LEVF &ge;60%, 89.5% pts had &ge;1&nbsp;cardiovascular risk factor (CVRF), 18.4% had peripheral arterial or cerebrovascular disease (PA/CVD),&nbsp;94.7% pts took anti-thrombotics (86,8% anti-platelets and 7.9% anticoagulants) and all took anti-lipids (71.0% statins, 5.3% ezetimib, 26.7% both).&nbsp;</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">Median calcium score was 17 (IQR 231) and 32 pts completed CCT: 7, 24 and 1 patients had ISHLT-CAV classification of 0, 1 and 2, respectively. Most patients (37.5%) had both calcified and hypodense plaques and median number of affected segments was 2 (IQR 3). </span></span></span></span></p>

<p><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">The remained 6 pts had extensive coronary calcification and a CA was performed: 3, 1 and 2 had ISHLT-CAV classification of 1, 2 and 3, respectively. Four (10.5%) pts needed additional ischemia testing: the one with CAV3 and both the pts with CAV2; also one pt with CAV1 but suboptimal quality of CCT&nbsp;images. </span></span></span></span></p>

<p><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">CCT&nbsp;also detected cardiac thrombus and pulmonary nodules in 2 and 4 pts, respectively. </span></span></span></span></p>

<p><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">Findings in CCT&nbsp;lead to therapeutic changes in 10 (26.3%)&nbsp;pts &ndash; all had changes in anti-lipids. One pt also changed anti-thrombotics and anti-hypertensive&nbsp;(aspirin to warfine due to cardiac thrombus and titulation of amlodipine)&nbsp;and other pt with CAV1 with hypondense plaques and 21 years of graft switched immunosuppressant to everolimus.&nbsp;Therapeutic changes were associated with diabetes after HT (p=0,043), but there were&nbsp;no significant associations with other CVRF, sex, age, previous PA/CVD, ischemic etiology, graft duration, plaque characteristics, calcium score, CAV classification nor previous rejection.&nbsp;However, our small sample size may not have the power to expose such associations.</span></span></span></span></p>

<p><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">During the mean follow up of 12,2&plusmn;4,2 months, there were no deaths, PCI, ACS, ventricular arrythimias or stroke. 3 pts&nbsp;had de novo rejection (1 humoral, 1 celular and 1 both) &ndash; the last one, evolved from CAV1 to CAV3 and was submitted to a new heart transplant. </span></span></span></span></p>

<p><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">Conclusions: </span></span></strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">Therapeutic changes (mainly anti-lipids) occurred in about 25% of pts after CCT, and were only associated with diabetes after HT. More studies are needed to access how CCT may guide therapy according to&nbsp;&nbsp;plaque burden.&nbsp;</span></span></span></span></p>