Inhomogeneous myocardial stress perfusion in SPECT studies predicts future allograft dysfunction in heart transplant recipientsReport as inadecuate




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EJNMMI Research

, 5:51

First Online: 05 October 2015Received: 18 August 2015Accepted: 23 September 2015DOI: 10.1186-s13550-015-0129-8

Cite this article as: Wenning, C., Vrachimis, A., DellAquila, A. et al. EJNMMI Res 2015 5: 51. doi:10.1186-s13550-015-0129-8

Abstract

BackgroundMyocardial perfusion gated single photon emission computed tomography SPECT can be used for non-invasive detection of coronary artery stenosis and cardiac allograft vasculopathy CAV, which is a crucial factor for the long-term survival of heart transplant HTx recipients. A frequently observed finding in myocardial perfusion imaging of patients after HTx is inhomogeneous myocardial perfusion. This finding is not associated with epicardial CAV, but its prognostic relevance is unclear so far. We therefore evaluated the prognosis of patients with homogeneous versus inhomogeneous myocardial stress perfusion.

MethodsOne hundred four HTx patients mean 3.6 ± 2.9 years after HTx without significant stress-induced ischemia summed stress score ≤3 in gated SPECT and without CAV were included. Myocardial stress perfusion was visually assessed as homogeneous, moderately, or severely inhomogeneous. The mean follow-up period after SPECT was 9.4 ± 3.1 years. End points were the diagnosis of CAV, major cardiac events MACE or death, and the development of allograft dysfunction left ventricular ejection fraction, LVEF <45 %.

ResultsOf all HTx patients, 24 % enrolled in this study n = 25 presented with inhomogeneous myocardial perfusion. Compared to the patients with homogeneous perfusion, these patients were at higher risk for developing allograft dysfunction multivariate hazard ratio, HR = 5.59. As to the development of CAV, the occurrence of MACE, or death, no statistical differences were observed between patients with homogenous and inhomogeneous perfusion. There was no correlation between myocardial perfusion pattern and prior cardiac allograft rejections.

ConclusionsInhomogeneous myocardial stress perfusion in SPECT studies predicts a higher risk for future development of allograft dysfunction in HTx patients LVEF <45 % but is not associated with future CAV, MACE, or overall survival.

KeywordsHeart transplantation Gated perfusion SPECT Inhomogeneous myocardial perfusion Cardiac allograft vasculopathy Ejection fraction AbbreviationsASNCAmerican Society of Nuclear Cardiology

BMIbody mass index

CADcoronary artery disease

CAVcardiac allograft vasculopathy

EDVenddiastolic volume

ESVendsystolic volume

HRhazard ratio

HTxheart transplantation

LVEFleft ventricular ejection fraction

MACEmajor cardiac event

MPHRmaximum predicted heart rate

MPImyocardial perfusion imaging

MBqmegabecquerel

OSoverall survival

PETpositron emission computed tomography

SDSsummed difference score

SPECTsingle photon emission computed tomography

SRSsummed rest score

SSSsummed stress score

TTEtransthoracic echocardiogram

Christian Wenning and Alexis Vrachimis contributed equally to this work.

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Author: Christian Wenning - Alexis Vrachimis - Angelo DellAquila - Alvyda Penning - Jörg Stypmann - Michael Schäfers

Source: https://link.springer.com/







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