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Updated: Aug 25, 2026
In Vivo Quantitative Assessment of Myocardial Structure, Function, Perfusion and Viability Using Cardiac Micro-computed Tomography
Published on: February 16, 2016
Inhomogeneous myocardial stress perfusion in SPECT studies predicts future allograft dysfunction in heart transplant
Christian Wenning1, Alexis Vrachimis2, Angelo Dell Aquila3
1Department of Nuclear Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, 48149, Münster, Germany. cwenning@uni-muenster.de.
Insights
Inhomogeneous myocardial stress perfusion in heart transplant patients indicates a higher risk of future allograft dysfunction. This finding does not predict cardiac allograft vasculopathy, major adverse cardiac events, or survival.
Area of Science:
- Cardiology
- Nuclear Medicine
- Transplant Medicine
Background:
- Myocardial perfusion gated single photon emission computed tomography (SPECT) is vital for detecting coronary artery stenosis and cardiac allograft vasculopathy (CAV) in heart transplant (HTx) recipients.
- Inhomogeneous myocardial perfusion is common post-HTx but its prognostic significance, independent of epicardial CAV, remains unclear.
Purpose of the Study:
- To evaluate the prognostic relevance of homogeneous versus inhomogeneous myocardial stress perfusion in HTx patients.
Main Methods:
- 104 HTx patients (mean 3.6 years post-transplant) without significant ischemia or CAV underwent gated SPECT.
- Myocardial stress perfusion was assessed visually (homogeneous, moderately, or severely inhomogeneous).
- Follow-up (mean 9.4 years) assessed for CAV, major adverse cardiac events (MACE), death, and allograft dysfunction (LVEF <45%).
Main Results:
- 24% of patients (n=25) showed inhomogeneous myocardial perfusion.
- Inhomogeneous perfusion was associated with a significantly higher risk of allograft dysfunction (HR=5.59).
- No significant differences were found for CAV development, MACE, death, or correlation with prior rejections.
Conclusions:
- Inhomogeneous myocardial stress perfusion on SPECT predicts increased risk of future allograft dysfunction in HTx patients.
- This pattern is not linked to future CAV, MACE, or overall survival.
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.
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