PET Assessment of Epicardial Intimal Disease and Microvascular Dysfunction in Cardiac Allograft Vasculopathy

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:71

Article

Chih, Sharon¹  Chong, Aun Yeong²  Erthal, Fernanda³  deKemp, Robert A.³  Davies, Ross A.¹  Stadnick, Ellamae¹  So, Derek Y.²  Overgaard, Christopher⁴  Wells, George⁵  Mielniczuk, Lisa M.¹  Beanlands, Rob S. B.³ 

[1] Univ Ottawa, Inst Heart, Dept Med, Heart Failure & Transplantat,Div Cardiol, Ottawa, ON, Canada

[2] Univ Ottawa, Inst Heart, Dept Med, Intervent Cardiol,Div Cardiol, Ottawa, ON, Canada

[3] Univ Ottawa, Inst Heart, Dept Med, Cardiac Imaging,Div Cardiol, Ottawa, ON, Canada

[4] Toronto Gen Hosp, Univ Hlth Network, Div Cardiol, Toronto, ON, Canada

[5] Univ Ottawa, Inst Heart, Cardiovasc Res Methods Ctr, Div Cardiol,Dept Med, Ottawa, ON, Canada

关键词: cardiac allograft vasculopathy;    flow quantification;    flow reserve;    heart transplantation;    intravascular ultrasound;    positron emission tomography;   

DOI  :  10.1016/j.jacc.2018.01.062

来源: Elsevier

【 摘 要 】

BACKGROUND Cardiac allograft vasculopathy (CAV) is a leading cause of graft failure and death after heart transplantation. Absolute myocardial blood flow (MBF) quantification using rubidium 82 (Rb-82) positron emission tomography (PET) could enable evaluation of diagnostically challenging diffuse epicardial and microvascular disease in CAV. OBJECTIVES The authors aimed to evaluate Rb-82 PET detection of CAV. METHODS Consecutive transplant recipients undergoing coronary angiography were prospectively evaluated with PET, multivessel intravascular ultrasound (IVUS), and intracoronary hemodynamics. CAV was defined as International Society of Heart and Lung Transplantation CAV(1-3) on angiography and maximal intimal thickness >= 0.5 mm on IVUS. RESULTS Forty patients (mean age 56 years, 4.8 years post-transplant) completed evaluation. CAV was detected in 32 patients (80%) by IVUS and 14 (35%) by angiography. PET correlated significantly with invasive coronary flow indices: r = 0.29, rate-pressure product-adjusted myocardial flow reserve (cMFR) versus coronary flow reserve; r = 0.28, relative flow reserve versus fractional flow reserve; and r = 0.37, coronary vascular resistance (CVR) versus index of microcirculatory resistance. Patients with CAV or microvascular dysfunction had reduced cMFR and stress MBF and increased CVR. Receiver operator characteristic curves demonstrated good accuracy of PET for CAV on IVUS (area under the curve 0.77 to 0.81) and optimal diagnostic cutoffs of cMFR < 2.9, stress MBF < 2.3, and CVR > 55. Combined PET assessment for CAV yielded excellent > 93% sensitivity (> 65% specificity) for 1 abnormal parameter and > 96% specificity (> 55% sensitivity) for 2 abnormal parameters. CONCLUSIONS Rb-82 PET flow quantification has high diagnostic accuracy for CAV, with potential for noninvasive evaluation after heart transplantation. (c) 2018 by the American College of Cardiology Foundation.

【 授权许可】

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