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. CONCLUSIONS VECAC is an independent prognostic marker of death/retransplantation following HT and merits inclusion as a part of post-HT surveillance PET/CT.

中文翻译：

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增加了心脏移植受者目测冠状动脉钙化的预后价值。


背景 心脏混合正电子发射断层扫描/计算机断层扫描 （PET/CT） 已成为心脏移植 （HT） 后心脏同种异体移植血管病变 （CAV） 的有效筛查方式。目测的冠状动脉钙化 （VECAC） 可以从作为 PET/CT 一部分获得的 CT 图像中量化，并且已被证明与冠状动脉疾病的不良心血管结局相关。我们调查了 HT 后 VECAC 的预后价值。方法 对 2016年至 2019 年接受 13N-氨心脏 PET/CT 的连续 430 例成年 HT 患者进行回顾性分析，随访至 2022 年 10 月 15 日。VECAC 类别包括：VECAC 0、VECAC 1-9、VECAC 10-99 和 VECAC 100+。使用单变量和多变量比例风险回归评估 VECAC 类别与结果之间的关联。主要结局是死亡/再移植。结果 队列中 73% 为男性，33% 患有糖尿病，67% 估计肾小球滤过率 <60 ml/min，中位年龄为 61 岁，自 HT 以来的中位时间为 7.5 年。单独的 VECAC 对筛查 CAV 的敏感性不足。在中位随访 4.2 年期间，90 名患者经历了死亡或再移植。与 VECAC 0 患者相比，VECAC 10-99 （HR 2.25,95% CI 1.23-4.14，p = 0.009） 和 VECAC 100+ （HR 3.42,95% CI 1.96-5.99，p < 0.001） 死亡/再移植风险增加。心血管死亡和心血管住院治疗的关联相似。在调整了死亡/再移植的其他预测因素后，VECAC 10-99 （VECAC 10-99： aHR 1.95， 95% CI 1.03-3.71 p = 0.04） 和 VECAC 100+ （VECAC 100+： aHR 2.33,95% CI 1.17-4.63，p = 0.02） 仍然与死亡/再移植独立相关。结论 VECAC 是 HT 后死亡/再移植的独立预后标志物，值得作为 HT 后监测 PET/CT 的一部分。