Heart failure & cardiomyopathies
Computed tomography pericoronary adipose tissue density predicts coronary allograft vasculopathy and adverse clinical outcomes after cardiac transplantation
Authors' conclusion
Heart transplant patients with CAV have higher PCAT density and lower V/M than those without. Increased PCAT density is associated with adverse clinical outcomes.
Study context
- Population
- Heart transplant patients undergoing coronary computed tomography angiography (CCTA), 2010–2021 (mean age 49, 40% female)126 CCTAs from 94 heart transplant patients
- Participants
- 40 / 86 / 12
- Exposure
- Heart transplant patients with coronary allograft vasculopathy (CAV) vs without CAV vs controls
- CAVn = 40
- Without CAVn = 86
- Controlsn = 12reference
- Outcome
- PCAT density on CCTA as a marker of inflammatory disease activity in CAV
Methodological detailsage- and sex-matched controls
- Age- and sex-matched controls
Main finding
As reported in the abstract
CAV
−73.0
SD 9.3 · HU
Without CAV
−77.9
SD 8.2 · HU
Controls
−86.2
SD 5.4 · HU
- Pericoronary adipose tissue (PCAT) density higher with CAV than without CAV and than controls
- P < 0.01 for both
Observational data: associations, not effects.
Further findings
All-cause mortality, PCAT density above −66 HU · over 5.3 (SD 2.1) years
| Comparison | OR (95% CI) | P value | |
|---|---|---|---|
| PCAT density above −66 HU | 18.0 (3.25–99.6) | P < 0.01 | |
| 0.050.21520Odds ratio (log scale) |
Composite of death, CAV progression, acute rejection, coronary revascularization, PCAT density above −66 HU · over 5.3 (SD 2.1) years
| Comparison | OR (95% CI) | P value | |
|---|---|---|---|
| PCAT density above −66 HU | 7.47 (1.8–31.6) | P = 0.01 | |
| 0.050.21520Odds ratio (log scale) |
mm3/g
| Outcome | CAV | Without CAV | Controls | |
|---|---|---|---|---|
| Vessel volume-to-myocardial mass ratio (V/M) | 32.4 (SD 9.7) | 41.4 (SD 12.3) | Not reported in the abstract | Controls: not reported in the abstract |
- Vessel volume-to-myocardial mass ratio (V/M) — V/M lower with CAV
- P < 0.0001
Prediction of CAV (PCAT density and V/M added to donor age and donor hypertension)
- AUC improved from 0.75 to 0.85
- P < 0.0001
Lesion composition, CAV vs atherosclerotic CAD (n = 32)
- CAV lesions predominantly non-calcified, mostly fibrous or fibrofatty tissue
Original publication
Summarised from the published abstract; every number is checked against it