129 Incidence and Predictors of Late Rejection after Cardiac Transplantation

for the diagnosis of coronary disease in non-transplant patients, but few studies have been done after HT. Methods and Materials: 118 HT patients, 1 to 24 years post transplant (mean 12years SD 6) underwent retrospective ECG gated 64-slice CTA without the use of any beta-blockers to slow the heart rate. Fifteen coronary segments were analyzed and reported by an independent investigator blinded to the results of ICA. Results: CTA images were systematically analyzed for image quality and the presence of CAV. Despite a mean resting heart rate of 82 bpm SD 13 and body mass index of 27kg/m SD 5, 81% of the CTA images were graded as excellent or satisfactory. The status of each of the 1755 segments assessed by CTA irrespective of the image quality was compared with the findings from ICA. CTA had sensitivity, specificity, positive and negative predictive values of 71%, 79%, 72% and 78% respectively for the detection of any CAV found by ICA. On a patient basis, CTA best performed in diagnosing CAV with more than 25% stenosis with sensitivity, specificity, positive and negative predictive values of 74%, 94%, 79%, and 92% respectively. None of the 61 patients with completely normal CTA had CAV on ICA. Non-coronary cardiac and non-cardiac abnormalities were identified in 18% and 14% of patients respectively. 83 (92%) out of 90 patients who responded to a patient survey preferred CTA to ICA as a screening test for CAV. Conclusions: The study shows that CTA compares favourably with ICA in detecting CAV in Heart Transplant recipients, and may be a preferable screening technique because of its non invasive nature, patient preference and yield of additional information.