Comprehensive non-invasive assessment of cardiac allograft vasculopathy and myocardial involvement in heart transplant patients using cardiac computed tomography

Median ECV_CT was significantly higher in HT patients (34%, IQR 30-38) compared to controls (29%, IQR 27-31; p < 0.001). ECV_CT was highly correlated with MR-ECV (r = 0.88, p < 0.001). In HT recipients, elevated ECV_CT was independently associated to hypertension , smoking, presence of CAV, elevated CAD-RADS scores and a history of graft rejection, whereas in controls only higher coronary artery calcium scores correlated with increased ECV_CT. CONCLUSION: ECV_CT is increased in HT patients compared to controls and associated with rejection history and CAV. ECV_CT emerges as a promising noninvasive tool for the simultaneous assessment of myocardial alterations and CAV in HT patients showing strong concordance with CMR and high reproducibility. Further multicenter studies are warranted to confirm its role in transplant surveillance protocols.