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PET/CT with Myocardial Blood Flow Assessment Is Prognostic of Cardiac Allograft Vasculopathy Progression and Clinical

Nikil Prasad1, Erin Harris1, Ersilia M DeFilippis1

  • 1Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, New York, New York.

Journal of Nuclear Medicine : Official Publication, Society of Nuclear Medicine
|January 17, 2025
PubMed

Insights

Noninvasive cardiac allograft vasculopathy (CAV) assessment using 13N-ammonia PET/CT provides prognostic insights. This method offers high negative predictive value, potentially allowing extended intervals between invasive screenings for heart transplant recipients.

Area of Science:

  • Cardiovascular Imaging and Nuclear Medicine
  • Transplant Cardiology
  • Medical Diagnostics

Background:

  • Cardiac allograft vasculopathy (CAV) significantly increases morbidity and mortality post-heart transplant.
  • Current diagnostic methods for CAV, including invasive coronary angiography (ICA), carry risks and necessitate frequent monitoring.
  • There is a need for noninvasive methods to accurately assess CAV and predict patient outcomes.

Purpose of the Study:

  • To evaluate the prognostic value of 13N-ammonia PET/CT myocardial perfusion imaging in assessing cardiac allograft vasculopathy (CAV) in heart transplant recipients.
  • To determine the negative predictive value (NPV) of PET/CT for the development of moderate to severe CAV (ISHLT CAV 2/3) over extended intervals.
  • To correlate PET/CT findings with clinical outcomes, including all-cause mortality and retransplantation.

Main Methods:

  • 344 heart transplant recipients underwent 13N-ammonia PET/CT for CAV assessment, with data analyzed alongside invasive coronary angiography (ICA) using validated grading scales.
  • CAV progression was tracked using serial ICA and PET/CT with myocardial blood flow reserve measurements at intervals of 600, 900, and 1200 days.
  • Negative predictive values (NPVs) for CAV development were calculated, and hazard ratios were used to assess the risk of mortality and retransplantation associated with PET/CT findings.

Main Results:

  • PET/CT grades 0/1 demonstrated high NPVs (0.93-0.95) for developing ISHLT CAV 2/3 on subsequent ICA.
  • PET CAV grade 2/3 was associated with a 2.9-fold increased risk of all-cause mortality (HR 2.86). PET CAV grade 1 showed a numerically increased risk (HR 2.03).
  • In a subgroup with stable CAV, PET CAV 2/3 remained significantly associated with increased risk of death or retransplantation (HR 3.20).

Conclusions:

  • Noninvasive assessment of CAV using 13N-ammonia PET/CT and myocardial blood flow reserve provides valuable prognostic information.
  • PET/CT demonstrates robust NPVs for predicting moderate to severe CAV, supporting the potential to extend surveillance intervals up to 4 years in select patients.
  • These findings suggest that PET/CT can aid in optimizing monitoring strategies for heart transplant recipients, potentially reducing the need for frequent invasive procedures.

Keywords:
PET/CTcardiac allograft vasculopathyheart transplantpredictionprognosis

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