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Published on: February 16, 2016
Quantitative CZT SPECT Myocardial Blood Flow for Physiological Assessment and Risk Stratification of Cardiac
Paul Hart1, Anas Jawaid1, Jeffrey Fitch1
1Cardiology Division, Department of Medicine (P.H., A.J., J.F., N.A., E.M.A., M.L.M., S.L., S.A., P.B., L.C., R.G.S.), University of Rochester, NY.
Insights
Quantitative CZT SPECT-derived myocardial blood flow (MBF) shows promise for assessing cardiac allograft vasculopathy (CAV) after heart transplantation. This accessible imaging technique aids in risk stratification and may improve patient surveillance strategies.
Area of Science:
- Cardiology
- Nuclear Medicine
- Transplantation Medicine
Background:
- Cardiac allograft vasculopathy (CAV) is a significant complication following heart transplantation.
- Current imaging methods like PET MBF are effective but have limited accessibility.
- Cadmium-zinc-telluride (CZT) SPECT offers a potentially more accessible quantitative MBF assessment.
Purpose of the Study:
- To evaluate the diagnostic and prognostic value of quantitative CZT SPECT-derived MBF for CAV.
- To compare the performance of established and modified flow-based algorithms for CAV detection.
- To assess the association of quantitative MBF parameters with CAV-related clinical events.
Main Methods:
- Retrospective study of 110 heart transplant recipients undergoing coronary angiography and CZT SPECT MBF imaging.
- Comparison of stress MBF, rest MBF, and MBF reserve across CAV severity grades.
- Evaluation of Bravo and Hart algorithms using receiver operating characteristic analysis.
- Assessment of associations between coronary flow capacity and CAV-related events.
Main Results:
- Stress MBF declined progressively with increasing CAV severity (P=0.007).
- Severely reduced coronary flow capacity was linked to higher event rates (28.6% vs. 5.2%, P=0.015).
- The Hart framework showed exploratory prognostic separation (35.3% vs. 3.2%, P=0.001).
Conclusions:
- Quantitative CZT SPECT-derived MBF and coronary flow capacity offer physiological assessment and risk stratification for CAV.
- Preliminary findings suggest CZT SPECT MBF is associated with CAV-related events.
- Further multicenter evaluation of CZT SPECT MBF is supported for noninvasive heart transplant surveillance.
Background:
Cardiac allograft vasculopathy (CAV) remains a major cause of morbidity and mortality after orthotopic heart transplantation. Although positron emission tomography myocardial perfusion imaging with quantitative myocardial blood flow (MBF) effectively detects CAV, access remains limited. Cadmium-zinc-telluride (CZT) single-photon emission computed tomography (SPECT) enables quantitative MBF assessment and may provide a more accessible alternative. However, the diagnostic and prognostic value of quantitative CZT SPECT-derived MBF for CAV is unknown.
Methods:
We retrospectively studied 110 consecutive orthotopic heart transplantation recipients who underwent coronary angiography and CZT SPECT quantitative MBF imaging within 12 months. Stress MBF, rest MBF, MBF reserve, coronary flow capacity, and total perfusion deficit were compared across International Society for Heart and Lung Transplantation CAV categories. The diagnostic performance of the established (Bravo) and modified (Hart) flow-based algorithms was evaluated by receiver operating characteristic analysis. Associations with CAV-related events were assessed.
Results:
Over 2.3±1.0 years, stress MBF declined progressively with increasing CAV severity (P=0.007) and was lower in patients with CAV 2 to 3 than in those with CAV 0 to 1 (1.25±0.52 versus 2.03±0.81 mL/min per g; P=0.003). The Bravo and Hart algorithms showed similar discrimination of advanced CAV by paired DeLong comparison (area under the curve, 0.773 versus 0.717; Δ area under the curve, 0.056; P=0.606). Severely reduced coronary flow capacity was associated with higher event rates (28.6% versus 5.2%; P=0.015). The Hart framework demonstrated exploratory prognostic separation (35.3% versus 3.2%; P=0.001).
Conclusions:
Quantitative CZT SPECT-derived MBF and coronary flow capacity provide physiological assessment and risk stratification of CAV, with preliminary associations with CAV-related events. These findings support the prospective multicenter evaluation of CZT SPECT MBF as a widely available, noninvasive orthotopic heart transplantation surveillance strategy.
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