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Normal Values for 13N-Ammonia PET-derived Metrics in Heart Transplant Patients.
Kevin J O'Gorman1, Luca Bremner2, Zayd Mian3
1Seymour, Paul and Gloria Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, NY, United States; United States Air Force, San Antonio, TX, United States.
Summary
This study defines normal myocardial blood flow and reserve values using cardiac PET in heart transplant recipients. These software-specific reference values aid in accurately assessing cardiac allograft vasculopathy over time.
Area of Science:
- Cardiovascular Imaging
- Nuclear Cardiology
- Transplant Medicine
Background:
- Cardiac positron emission tomography (PET) is crucial for detecting cardiac allograft vasculopathy (CAV).
- Limited patient-specific normal values for myocardial blood flow (MBF), myocardial blood flow reserve (MBFR), and left ventricular parameters exist for heart transplant (HT) recipients.
- Accurate reference ranges are needed for effective CAV monitoring.
Purpose of the Study:
- To establish normal reference ranges for MBF, MBFR, and left ventricular parameters in HT recipients using two software programs.
- To assess the agreement between metrics derived from different software.
- To provide software-specific thresholds for longitudinal assessment of CAV.
Main Methods:
- Retrospective analysis of 266 HT recipients undergoing 13N-ammonia PET (2021-2023).
- Inclusion of patients without ischemia or scar, compared with invasive coronary angiography and intravascular ultrasound.
- Derivation of normal values using Invia-4DM and Cedars-Sinai software in patients without angiographic CAV and micro-intimal disease.
- Agreement assessed via correlation and Bland-Altman analyses.
Main Results:
- Ninety-three patients met criteria for normal reference value derivation.
- Rate-pressure-product correction significantly influenced MBFR.
- Lower limits of normal for MBFR ranged from 1.80-2.37, varying by software and residual subtraction.
- Software-derived metrics showed strong relationships and moderate-to-good agreement, but wide limits of agreement for MBF metrics.
Conclusions:
- Software-specific normal reference values for 13N-ammonia PET metrics in HT recipients without CAV were established.
- Findings support the use of software-specific thresholds for longitudinal assessment.
- Consistent post-processing is recommended for accurate monitoring in transplant populations.
