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Prognostic utility of longitudinal quantification of PET myocardial blood flow early post heart transplantation

  • ORIGINAL ARTICLE
  • Published:
Journal of Nuclear Cardiology Aims and scope

Abstract

Background

Myocardial blood flow (MBF) quantification by Rubidium-82 positron emission tomography (PET) has shown promise for cardiac allograft vasculopathy (CAV) surveillance and risk stratification post heart transplantation. The objective was to determine the prognostic value of serial PET performed early post transplantation.

Methods and Result

Heart transplant (HT) recipients at the University of Ottawa Heart Institute with 2 PET examinations (PET1 = baseline, PET2 = follow-up) within 6 years of transplant were included in the study. Evaluation of PET flow quantification included stress MBF, coronary vascular resistance (CVR), and myocardial flow reserve (MFR). The primary composite outcome was all-cause death, re-transplant, myocardial infarction, revascularization, allograft dysfunction, cardiac allograft vasculopathy (CAV), or heart failure hospitalization. A total of 121 patients were evaluated (79% male, mean age 56 ± 11 years) with consecutive scans performed at mean 1.4 ± 0.7 and 2.6 ± 1.0 years post HT for PET1 and PET2, respectively. Over a mean follow-up of 3.0 (IQR 1.8, 4.6) years, 26 (22%) patients developed the primary outcome: 1 death, 11 new or progressive angiographic CAV, 2 percutaneous coronary interventions, 12 allograft dysfunction. Unadjusted Cox analysis showed a significant reduction in event-free survival in patients with PET1 stress MBF < 2.1 (HR: 2.43, 95% CI 1.11-5.29 P = 0.047) and persistent abnormal PET1 to PET2 CVR > 76 (HR: 2.19, 95% CI 0.87-5.51 P = 0.045). There was no association between MFR and outcomes.

Conclusion

Low-stress MBF and persistent increased CVR on serial PET imaging early post HT are associated with adverse cardiovascular outcomes. Early post-transplant and longitudinal assessment by PET may identify at-risk patients for increased surveillance post HT.

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Abbreviations

HT:

Heart transplantation

CAV:

Cardiac allograft vasculopathy

PET:

Positron emission tomography

MBF:

Myocardial blood flow

MFR:

Myocardial flow reserve

cMFR:

Corrected myocardial flow reserve

CVR:

Coronary vascular resistance

IMR:

Index of microcirculatory resistance

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Disclosure

At present, there are no known conflicts of interest associated with the principal or co-investigators of this research study or any member of their immediate family. Rob Beanlands is a consultant (<$5000/year) for Lantheus Medical Imaging, GE Healthcare, and Jubilant DRAXimage. He receives research funds (>$10,000/year) from Lantheus Medical Imaging, Jubilant DRAXimage, and GE Healthcare. Rob deKemp receives royalties from Rubidium PET technologies licensed to Jubilant DRAXimage and INVIA Medical Imaging. He is conducting research sponsored by Lantheus Medical Imaging and Jubilant DRAXimage. Christiane Wiefels, Aws Almufleh, Jason Yao, Aun-Yeong Chong, Lisa Marie Mielniczuk, Ellamae Stadnick, Ross A. Davies, and Sharon Chih have no disclosures.

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Author notes

  1. Christiane Wiefels and Aws Almufleh contributed equally to this work (First co-authors).

Authors and Affiliations

  1. Cardiology, University of Ottawa Heart Institute, 40, Ruskin Street, Ottawa, ON, K1Y 4W7, Canada

    Christiane Wiefels MD, MSc, Aws Almufleh MD, MPH, FRCPC, Jason Yao BSc, Robert A. deKemp PhD, PEng, PPhys, Aun-Yeong Chong MD, MRCP, Lisa Marie Mielniczuk MSc, MD, FRCPC, Ellamae Stadnick MD, MSc, FRCPC, Ross A. Davies BSc, MD, Rob S. Beanlands MD, FRCPC & Sharon Chih MBBS, PhD

  2. Pós-graduação em Ciências Cardiovasculares, Universidade Federal Fluminense, Niterói, Brazil

    Christiane Wiefels MD, MSc

  3. Cardiac Sciences Department, King Saud University, Riyadh, Saudi Arabia

    Aws Almufleh MD, MPH, FRCPC

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  1. Christiane Wiefels MD, MSc
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Correspondence to Sharon Chih MBBS, PhD.

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Funding

Dr. Wiefels is supported by the University of Ottawa Heart Institute Division of Cardiology Kaufman-Chan Endowed Fellowship and by CAPES (Coordenação de Aperfeiçoamento de Nível Superior) from Brazil. Dr. Beanlands is supported by the University of Ottawa Heart Institute Heart Institute Vered Chair in Cardiology and University of Ottawa Tier 1 chair in Cardiac Research. He was supported as a Career Investigator from the Heart and Stroke Foundation Ontario. Dr. Chih is supported by a Heart and Stroke Foundation (HSF) of Ontario Clinician Scientist award. This work was supported in part by the HSF of Canada (Grant #G-17-0018310).

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Wiefels, C., Almufleh, A., Yao, J. et al. Prognostic utility of longitudinal quantification of PET myocardial blood flow early post heart transplantation. J. Nucl. Cardiol. 29, 712–723 (2022). https://doi.org/10.1007/s12350-020-02342-7

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  • DOI: https://doi.org/10.1007/s12350-020-02342-7

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