Single photon emission computed tomography myocardial perfusion imaging to detect cardiac allograft vasculopathy

David Thompson, Matthew Koster, Robert H. Wagner, Alain Heroux, John T. Barron

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Aims: Cardiac allograft vasculopathy (CAV) is a major cause of morbidity and mortality in cardiac transplant recipients. This study evaluates the usefulness of single photon emission computed tomography (SPECT) and various SPECT-derived diastolic variables to detect CAV in heart transplant patients. Methods and results: A retrospective review of 141 SPECT studies with corresponding coronary angiograms within 12 months was performed on 99 transplant recipients. Diastolic function was assessed using computer-derived measures of peak filling rate (PFR), time to peak filling rate (TPFR), and mean first one-third filling rate (MFR/3). Angiography identified CAV in 53 of the 141 studies (38%). Of the 53, SPECT identified 7 with reversible myocardial defects (sensitivity 13%) and stress-induced electrocardiographic evidence of ischaemia was seen in one patient (sensitivity 2%). SPECT imaging was negative in 86 of the 88 negative coronary angiograms (specificity 98%). The positive predictive value and negative predictive value were 78 and 65%, respectively. If a more stringent definition of CAV was used (≥70% stenosis), the sensitivity and specificity were unchanged (14 and 98%, respectively). There was no statistical difference in diastolic variables between patients with or without angiographic evidence of CAV in regard to PFR (3.57+1.14 vs. 3.18±1.21 EDV/s, P = 0.90), TPFR (149±32 vs. 153±43 ms, P = 0.33), or MFR/3 (1.37±0.43 vs. 1.27±0.42 EDV/s, P = 0.94). Conclusion: Adenosine stress/rest technetium-99m tetrofosmin-gated SPECT is not a sensitive test for detection of CAV in heart transplant recipients. Diastolic dysfunction, as assessed by SPECT, was not shown to be associated with development of CAV. Published on behalf of the European Society of Cardiology. All rights reserved.

Original languageEnglish (US)
Pages (from-to)271-275
Number of pages5
JournalEuropean Heart Journal Cardiovascular Imaging
Volume13
Issue number3
DOIs
StatePublished - Mar 1 2012
Externally publishedYes

Fingerprint

Myocardial Perfusion Imaging
Single-Photon Emission-Computed Tomography
Allografts
Angiography
Adenosine
Pathologic Constriction
Ischemia
Morbidity
Transplants
Sensitivity and Specificity
Mortality
Transplant Recipients

Keywords

  • Cardiac allograft vasculopathy
  • Cardiac transplantation
  • Myocardial perfusion imaging
  • Single photon computed tomography

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Single photon emission computed tomography myocardial perfusion imaging to detect cardiac allograft vasculopathy. / Thompson, David; Koster, Matthew; Wagner, Robert H.; Heroux, Alain; Barron, John T.

In: European Heart Journal Cardiovascular Imaging, Vol. 13, No. 3, 01.03.2012, p. 271-275.

Research output: Contribution to journalArticle

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abstract = "Aims: Cardiac allograft vasculopathy (CAV) is a major cause of morbidity and mortality in cardiac transplant recipients. This study evaluates the usefulness of single photon emission computed tomography (SPECT) and various SPECT-derived diastolic variables to detect CAV in heart transplant patients. Methods and results: A retrospective review of 141 SPECT studies with corresponding coronary angiograms within 12 months was performed on 99 transplant recipients. Diastolic function was assessed using computer-derived measures of peak filling rate (PFR), time to peak filling rate (TPFR), and mean first one-third filling rate (MFR/3). Angiography identified CAV in 53 of the 141 studies (38{\%}). Of the 53, SPECT identified 7 with reversible myocardial defects (sensitivity 13{\%}) and stress-induced electrocardiographic evidence of ischaemia was seen in one patient (sensitivity 2{\%}). SPECT imaging was negative in 86 of the 88 negative coronary angiograms (specificity 98{\%}). The positive predictive value and negative predictive value were 78 and 65{\%}, respectively. If a more stringent definition of CAV was used (≥70{\%} stenosis), the sensitivity and specificity were unchanged (14 and 98{\%}, respectively). There was no statistical difference in diastolic variables between patients with or without angiographic evidence of CAV in regard to PFR (3.57+1.14 vs. 3.18±1.21 EDV/s, P = 0.90), TPFR (149±32 vs. 153±43 ms, P = 0.33), or MFR/3 (1.37±0.43 vs. 1.27±0.42 EDV/s, P = 0.94). Conclusion: Adenosine stress/rest technetium-99m tetrofosmin-gated SPECT is not a sensitive test for detection of CAV in heart transplant recipients. Diastolic dysfunction, as assessed by SPECT, was not shown to be associated with development of CAV. Published on behalf of the European Society of Cardiology. All rights reserved.",
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