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Diagnostic and prognostic value of myocardial perfusion gated SPECT in orthotopic heart transplant recipients

  • Original Article
  • Published:
Journal of Nuclear Cardiology Aims and scope

Abstract

Background

Cardiac allograft vasculopathy (CAV) limits long-term survival after heart transplantation. Diagnostic and prognostic value of gated single photon emission computed tomography (gated SPECT) has not been documented in this setting.

Methods and Results

We identified 110 consecutive heart transplant recipients (with transplantation >18 months) who underwent stress–rest gated SPECT and coronary angiography within 1 month, and were clinically monitored in a single heart transplantation center. Visual scoring of perfusion and wall motion images used a 16-segment model. Left ventricular function was automatically calculated. Coronary angiography was normal in 64 patients (58%) and abnormal in 46 (any CAV, 42%), of whom 19 had severe stenoses. Sensitivity and negative predictive (NPV) value were .63 and .75 for identification of any CAV, and .84 and .96 for severe CAV. Cox regression analysis showed that independent predictors of cardiac death and retransplantation were the presence of any angiographic CAV lesions (RR = 8.816, P = .043) and a stress perfusion defect >3 segments (RR = 5.607, P = .0053). A stress perfusion defect >3 segments predicted the need for late coronary revascularization >2 months (RR = 6.11, P = .0002).

Conclusions

We conclude that perfusion gated SPECT is a useful noninvasive screening test and may be proposed to help identify heart transplant recipients with a high risk of poor clinical outcome. A normal gated SPECT was associated with a low risk of cardiac hard event and might alleviate the need for coronary angiography.

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Authors and Affiliations

  1. Department of Nuclear Medicine, Rouen University Hospital, Henri Becquerel Center, Rouen, France

    Alain Manrique MD, PhD, Anne Hitzel MD & Pierre Véra MD, PhD

  2. Department of Human Investigations, GIP Cyceron, Bd Henri Becquerel, BP 5229, 14074, Caen Cedex 05, France

    Alain Manrique MD, PhD

  3. Department of Cardiology, Rouen University Hospital, Rouen, France

    Mathieu Bernard MD, Christophe Tron MD & Alain Cribier

  4. Department for Clinical Research in the North-Western Regions of France and Department of Biostatistics, Rouen University Hospital, Rouen, France

    Michael Bubenheim PhD

  5. Department of Nuclear Medicine, Caen University Hospital, Caen, France

    Alain Manrique MD, PhD & Denis Agostini MD, PhD

  6. Department of Cardiac Surgery, Rouen University Hospital, Rouen, France

    Jean Paul Bessou MD & Michel Redonnet MD

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  1. Alain Manrique MD, PhD
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  2. Mathieu Bernard MD
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Correspondence to Alain Manrique MD, PhD.

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See related editorial on doi:10.1007/s12350-010-9198-2.

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Manrique, A., Bernard, M., Hitzel, A. et al. Diagnostic and prognostic value of myocardial perfusion gated SPECT in orthotopic heart transplant recipients. J. Nucl. Cardiol. 17, 197–206 (2010). https://doi.org/10.1007/s12350-009-9166-x

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  • DOI: https://doi.org/10.1007/s12350-009-9166-x

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