Rotational coronary angiography in heart transplant recipients

As a screening method for detecting coronary lesions, coronary angiography (CAG) is becoming increasingly important in the activities of transplant centers. Angiography examination of coronary arteries is performed in potential recipients of various organs, related donors, and annually in heart recipients. Given the grave condition of recipients in the early post-transplant period and annual angiographic studies, it is necessary to strive for reduction of radiation load on the body and reduction of dose of X-ray contrast agents used.

Objective: to assess the possibilities of using rotational CAG in the activities of transplant centers.

Materials and methods. We observed 254 patients who underwent CAG. Their ages ranged from 21 to 79 years (mean 46.92 ± 1), and 90% were men. All patients were divided into two groups: group 1 included 142 patients who underwent rotational CAG, while group 2 was the control group (where classical polyprojection CAG was performed) and included 112 patients. Group 1 was divided into 2 subgroups – the subgroup of patients after heart transplantation who underwent endomyocardial biopsy along with CAG (n = 51), and the subgroup of patients who underwent only rotational CAG.

Results. In 91% of patients, CAG was performed by radial access. In group 1, stenotic lesions were detected in 33 patients: 19 had single-vessel lesions, 9 had two-vessel lesions, and 5 had three-vessel lesions. A total of 56 hemodynamically significant stenoses were detected, 9 of which were chronic total occlusions. In 83 patients (60%), performing only 2 series of rotational scans (one left and one right coronary artery) was sufficient. In 32 (23%) patients, one more clarifying projection was required, in 17 patients two and in 9 – 3–5 additional projections. In 3 cases, we switched to polyprojection CAG. The average amount of contrast agent used was 24.4 ± 0.9 ml, the average X-ray dose was 34561.3 ± 1695.2 mGycm². The need for a contrast agent was significantly higher in the comparison group – 24.4 ± 0.9 mL and 103.5 ± 1.7 mL, respectively. The average X-ray dose in the main group was 34561.3 ± 1695.2 mGycm², in the comparison group 41430.9 ± 4141.7 mGycm². However, there was no significant difference between the groups. Subgroup analysis showed that patients who underwent only rotational CAG had lower radiation exposure compared to patients who underwent CAG combined with endomyocardial biopsy biopsy (EMB), as well as significantly lower load compared to the control group.

Conclusion. Rotational CAG can be considered as the method of choice at transplant centers, where screening diagnostics of the state of the coronary bed is required, which is equivalent in terms of information content and safety. Rotational CAG allows to reduce the amount of injected contrast agent by more than three times, which in turn reduces the number of associated complications, as well as the radiation exposure of patients and medical personnel.

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