{
  "abstract": "Introduction Cardiac allograft vasculopathy (CAV) is an immune-mediated condition marked by progressive coronary intimal hyperplasia, representing a leading cause of late graft failure, morbidity, and mortality in heart transplant recipients. While invasive coronary angiography (CAG) remains the standard for CAV surveillance, advances in computed tomography coronary angiography (CTCA), particularly with higher-slice scanners, offer a promising non-invasive alternative, potentially overcoming challenges associated with higher heart rates in transplant patients. CTCA has a high negative predictive value and may be particularly accurate in this population, given their typically low coronary calcium burden. This audit aimed to evaluate the detection rate of significant coronary artery disease and CAV using invasive coronary angiography and assess its impact on post-transplant patient management.Method A retrospective audit was conducted at a large tertiary transplant centre, reviewing all elective diagnostic coronary angiograms performed in heart transplant patients between July 2020 and May 2023. Data on indications, angiographic findings, and subsequent management decisions were analysed.Results Among 58 heart transplant patients undergoing CAG, 81% (n=47) were male. All procedures utilized radial access and had a 0% complication rate. 62% (n=36) of CAGs were for patients within the first 6 years post-transplant. The median interval between surveillance angiograms was 4.4 years (IQR 3.3–5.1). Routine surveillance (asymptomatic patients) was the primary indication for CAG in 93% (n=54) of cases, while 5% (n=3) underwent CAG for symptoms and 2% (n=1) for allograft dysfunction. Findings revealed normal or mild coronary artery disease in 91% (n=53), moderate disease in 4% (n=2), and severe disease in 5% (n=3). Of the severe cases, two patients underwent percutaneous coronary intervention, and one was managed conservatively.Conclusion Invasive coronary angiography rarely altered management in this predominantly asymptomatic cohort. Given its safety and non-invasive nature, CTCA may serve as a viable alternative for CAV surveillance in asymptomatic heart transplant patients, potentially reducing the cumulative risks associated with repeated invasive procedures.Abstract 5-004 Figure 1Surveillance coronary angiogram findings for heart transplant patients",
  "authors": [
    {
      "affiliations": [
        "Department of Cardiology, Royal Papworth Hospital, Cambridge, UK"
      ],
      "name": "Majid Anwar"
    },
    {
      "affiliations": [
        "Department of Cardiology, Royal Papworth Hospital, Cambridge, UK"
      ],
      "name": "Ahmad Alajlouni"
    },
    {
      "affiliations": [
        "Department of Cardiology, Royal Papworth Hospital, Cambridge, UK"
      ],
      "name": "Stephen Pettit"
    },
    {
      "affiliations": [
        "Department of Cardiology, Royal Papworth Hospital, Cambridge, UK"
      ],
      "name": "Sai Bhagra"
    },
    {
      "affiliations": [
        "Department of Cardiology, Royal Papworth Hospital, Cambridge, UK"
      ],
      "name": "Stephen Hoole"
    },
    {
      "affiliations": [
        "Department of Cardiology, Royal Papworth Hospital, Cambridge, UK"
      ],
      "name": "Paul Bambrough"
    }
  ],
  "title": "5-004 Evaluating the role of invasive coronary angiography in cardiac allograft vasculopathy surveillance: a retrospective audit",
  "uid": "1bdc5c17-2580-5689-a880-0d349b2ea705"
}