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Inhomogeneous myocardial stress perfusion in SPECT studies predicts future allograft dysfunction in heart transplant recipients.

Wenning C, Vrachimis A, Dell Aquila A, Penning A, Stypmann J, Schäfers M - EJNMMI Res (2015)

Bottom Line: One 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.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 %).Inhomogeneous 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.

View Article: PubMed Central - PubMed

Affiliation: Department of Nuclear Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, 48149, Münster, Germany. cwenning@uni-muenster.de.

ABSTRACT

Background: Myocardial 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.

Methods: One 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 %).

Results: Of 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.

Conclusions: Inhomogeneous 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.

No MeSH data available.


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Cumulative incidence of allograft dysfunction. Comparison between patients with homogeneous and inhomogeneous perfusion (a) and more differentiated in patients with inhomogeneous perfusion and LVEF > versus <57 % (b)
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Fig3: Cumulative incidence of allograft dysfunction. Comparison between patients with homogeneous and inhomogeneous perfusion (a) and more differentiated in patients with inhomogeneous perfusion and LVEF > versus <57 % (b)

Mentions: In the follow-up, inhomogeneous myocardial perfusion was associated with a significantly more frequent decrease of LVEF <45 % (Fig. 3a). The univariate HR was 5.0 (95 % CI, 1.52–16.4; p < 0.01; Table 4). Particularly, the combined finding of inhomogeneous perfusion and LVEF ≤57 % (=threshold value calculated from control group data) in gated SPECT was associated with an increased risk for the development of allograft dysfunction (HR 3.5 [CI 1.74–6.98], p < 0.01; Fig. 3b).Fig. 3


Inhomogeneous myocardial stress perfusion in SPECT studies predicts future allograft dysfunction in heart transplant recipients.

Wenning C, Vrachimis A, Dell Aquila A, Penning A, Stypmann J, Schäfers M - EJNMMI Res (2015)

Cumulative incidence of allograft dysfunction. Comparison between patients with homogeneous and inhomogeneous perfusion (a) and more differentiated in patients with inhomogeneous perfusion and LVEF > versus <57 % (b)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4593982&req=5

Fig3: Cumulative incidence of allograft dysfunction. Comparison between patients with homogeneous and inhomogeneous perfusion (a) and more differentiated in patients with inhomogeneous perfusion and LVEF > versus <57 % (b)
Mentions: In the follow-up, inhomogeneous myocardial perfusion was associated with a significantly more frequent decrease of LVEF <45 % (Fig. 3a). The univariate HR was 5.0 (95 % CI, 1.52–16.4; p < 0.01; Table 4). Particularly, the combined finding of inhomogeneous perfusion and LVEF ≤57 % (=threshold value calculated from control group data) in gated SPECT was associated with an increased risk for the development of allograft dysfunction (HR 3.5 [CI 1.74–6.98], p < 0.01; Fig. 3b).Fig. 3

Bottom Line: One 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.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 %).Inhomogeneous 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.

View Article: PubMed Central - PubMed

Affiliation: Department of Nuclear Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, 48149, Münster, Germany. cwenning@uni-muenster.de.

ABSTRACT

Background: Myocardial 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.

Methods: One 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 %).

Results: Of 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.

Conclusions: Inhomogeneous 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.

No MeSH data available.


Related in: MedlinePlus