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PET/CT With Myocardial Blood Flow in Cardiac Allograft Vasculopathy
Quick Takes
- An algorithm using PET/CT imaging with regadenoson and Rb-82 imaging with myocardial blood flow (MBF) quantification offers a high negative predictive value to rule out significant cardiac allograft vasculopathy (CAV) in patients with heart transplant.
- The low rate of events in patients with low-risk PET CAV classifications suggests PET/CT with MBF may be a safe and effective alternative to screening exclusively with invasive coronary angiography.
- Additional multicenter trials and registries with serial PETs on patients with heart transplant are indicated to systematically evaluate the value of PET/CT with MBF in CAV in patients with a heart transplant.
Study Questions:
What is the diagnostic and prognostic value of a previously published algorithm for diagnosing cardiac allograft vasculopathy (CAV) via positron emission tomography/computed tomography (PET/CT) scan with myocardial blood flow (MBF) in a larger population?
Methods:
The investigators retrospectively identified patients with heart transplantation without prior revascularization who underwent PET/CT scans with MBF. The accuracy of the algorithm was assessed in patients who underwent PET/CT scanning within 1 year of invasive coronary angiography (ICA). The prognostic value was assessed via a composite outcome of heart failure hospitalization, myocardial infarction, retransplantation, and all-cause mortality. Event-free survival for the composite outcome and all-cause mortality were assessed via Kaplan-Meier survival curves with statistical significance determined by the log-rank test. The Cox proportional hazards model was used to assess univariate associations between the composite outcome and PET CAV score, PET MBF, and comorbidities.
Results:
A total of 88 patients for the diagnostic portion and 401 patients for the prognostic portion were included. PET CAV 0 had high negative predictive value for moderate to severe CAV (97%) and PET CAV 2/3 had a high positive predictive value for moderate to severe CAV (68%) by ICA. The cohort was followed for a median of 1.2 (interquartile range, 1.0-1.8) years with 46 patients having an adverse event. The annualized event rates were 6.9%, 9.3%, and 30.8% for PET CAV 0, 1, and 2/3, respectively (p < 0.001).
Conclusions:
The authors report that an algorithm using PET/CT scanning with MBF demonstrates a high negative predictive value for CAV.
Perspective:
This study reports that an algorithm using PET/CT imaging with regadenoson and rubidium-82 (Rb-82) imaging with MBF quantification offers a high negative predictive value to rule out significant CAV in patients with heart transplant. Furthermore, the low rate of events in patients with low-risk PET CAV classifications suggests PET/CT with MBF may be a safe and effective alternative to screening exclusively with ICA. Additional multicenter trials and registries with serial PETs on patients with heart transplant are indicated to systematically evaluate the value of PET/CT with MBF in CAV in patients with a heart transplant and the warranty period of a normal PET/CT with MBF.
Clinical Topics: Cardiac Surgery, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Prevention, Cardiac Surgery and Arrhythmias, Cardiac Surgery and Heart Failure, Acute Heart Failure, Heart Transplant, Interventions and Imaging, Angiography, Computed Tomography, Nuclear Imaging
Keywords: Allografts, Cardiac Surgical Procedures, Coronary Angiography, Tomography, X-Ray Computed, Diagnostic Imaging, Heart Failure, Heart Transplantation, Myocardial Infarction, Positron-Emission Tomography, Positron Emission Tomography Computed Tomography, Reoperation, Rubidium, Secondary Prevention
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