BACKGROUND: Survival after heart transplant has greatly improved, with median survival now over 12 years. Cardiac allograft vasculopathy (CAV) has become a major source of long-term morbidity and mortality. Single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) is used for CAV surveillance, but there is limited data on its prognostic utility. METHODS: We retrospectively identified patients undergoing SPECT MPI for CAV surveillance at a single, large-volume center. Images were assessed with semiquantitative visual scoring (summed stress score [SSS] and summed rest score) and quantitatively with total perfusion defect (TPD). RESULTS: We studied 503 patients (mean age 62.5, 69.3% male) at a median of 9.0 years post-transplant. During mean follow-up of 5.1 ± 2.5 years, 114 (22.6%) patients died. The diagnostic accuracy for significant CAV (ISHLT grade 2 or 3) was highest for SSS with an area under the curve of 0.650 and stress TPD (area under the curve, 0.648), with no significant difference between SSS and stress TPD (P = 0.061). Stress TPD (adjusted hazard ratio, 1.07; P = 0.018) was independently associated with all-cause mortality, while SSS was not (P = 0.064). The prognostic accuracy of quantitative assessment of perfusion tended to be higher compared with semiquantitative assessment, with the highest accuracy for stress TPD (area under the receiver operating curve 0.584). CONCLUSIONS: While SPECT MPI identified a cohort of higher risk patients, with quantitative analysis of perfusion demonstrating higher prognostic accuracy. However, the overall prognostic accuracy was modest and alternative noninvasive modalities may be more suitable for CAV surveillance.
BACKGROUND: Survival after heart transplant has greatly improved, with median survival now over 12 years. Cardiac allograft vasculopathy (CAV) has become a major source of long-term morbidity and mortality. Single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) is used for CAV surveillance, but there is limited data on its prognostic utility. METHODS: We retrospectively identified patients undergoing SPECT MPI for CAV surveillance at a single, large-volume center. Images were assessed with semiquantitative visual scoring (summed stress score [SSS] and summed rest score) and quantitatively with total perfusion defect (TPD). RESULTS: We studied 503 patients (mean age 62.5, 69.3% male) at a median of 9.0 years post-transplant. During mean follow-up of 5.1 ± 2.5 years, 114 (22.6%) patients died. The diagnostic accuracy for significant CAV (ISHLT grade 2 or 3) was highest for SSS with an area under the curve of 0.650 and stress TPD (area under the curve, 0.648), with no significant difference between SSS and stress TPD (P = 0.061). Stress TPD (adjusted hazard ratio, 1.07; P = 0.018) was independently associated with all-cause mortality, while SSS was not (P = 0.064). The prognostic accuracy of quantitative assessment of perfusion tended to be higher compared with semiquantitative assessment, with the highest accuracy for stress TPD (area under the receiver operating curve 0.584). CONCLUSIONS: While SPECT MPI identified a cohort of higher risk patients, with quantitative analysis of perfusion demonstrating higher prognostic accuracy. However, the overall prognostic accuracy was modest and alternative noninvasive modalities may be more suitable for CAV surveillance.
Authors: Omar Wever-Pinzon; Jorge Romero; Iosif Kelesidis; James Wever-Pinzon; Carlos Manrique; Deborah Budge; Stavros G Drakos; Ileana L Piña; Abdallah G Kfoury; Mario J Garcia; Josef Stehlik Journal: J Am Coll Cardiol Date: 2014-03-26 Impact factor: 24.094
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Authors: Sharon Chih; Aun Yeong Chong; Fernanda Erthal; Robert A deKemp; Ross A Davies; Ellamae Stadnick; Derek Y So; Christopher Overgaard; George Wells; Lisa M Mielniczuk; Rob S B Beanlands Journal: J Am Coll Cardiol Date: 2018-04-03 Impact factor: 24.094
Authors: Paco E Bravo; Brian A Bergmark; Tomas Vita; Viviany R Taqueti; Ankur Gupta; Sara Seidelmann; Thomas E Christensen; Michael T Osborne; Nishant R Shah; Nina Ghosh; Jon Hainer; Courtney F Bibbo; Meagan Harrington; Fred Costantino; Mandeep R Mehra; Sharmila Dorbala; Ron Blankstein; Akshay Desai; Lynne Stevenson; Michael M Givertz; Marcelo F Di Carli Journal: Eur Heart J Date: 2018-01-21 Impact factor: 29.983
Authors: D S Berman; H Kiat; J D Friedman; F P Wang; K van Train; L Matzer; J Maddahi; G Germano Journal: J Am Coll Cardiol Date: 1993-11-01 Impact factor: 24.094
Authors: Robert J H Miller; Jacek Kwiecinski; Kevin S Shah; Evann Eisenberg; Jignesh Patel; Jon A Kobashigawa; Babak Azarbal; Balaji Tamarappoo; Daniel S Berman; Piotr J Slomka; Evan Kransdorf; Damini Dey Journal: Am J Transplant Date: 2019-12-21 Impact factor: 8.086
Authors: Kevin J Clerkin; Maryjane A Farr; Susan W Restaino; Ziad A Ali; Donna M Mancini Journal: J Heart Lung Transplant Date: 2016-05-21 Impact factor: 10.247
Authors: Robert J H Miller; Osamu Manabe; Balaji Tamarappoo; Sean Hayes; John D Friedman; Piotr J Slomka; Jignesh Patel; Jon A Kobashigawa; Daniel S Berman Journal: J Nucl Med Date: 2019-08-26 Impact factor: 10.057