Prognostic value of rubidium-82 positron emission tomography in patients after heart transplant

• Published in: Circulation. Cardiovascular imaging Vol. 7; no. 6; pp. 930 - 937
• Main Authors: Mc Ardle, Brian A, Davies, Ross A, Chen, Li, Small, Gary R, Ruddy, Terrence D, Dwivedi, Girish, Yam, Yeung, Haddad, Haissam, Mielniczuk, Lisa M, Stadnick, Ellamae, Hessian, Renee, Guo, Ann, Beanlands, Rob S, deKemp, Robert A, Chow, Benjamin J W
• Format: Journal Article
• Language: English
• Published: United States 01-11-2014
• Subjects: Acute Coronary Syndrome - etiology; Acute Coronary Syndrome - mortality; Aged; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - etiology; Coronary Artery Disease - mortality; Coronary Artery Disease - physiopathology; Female; Fractional Flow Reserve, Myocardial; Heart Failure - etiology; Heart Failure - mortality; Heart Failure - therapy; Heart Transplantation - adverse effects; Heart Transplantation - mortality; Hospitalization; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Myocardial Perfusion Imaging - methods; Positron-Emission Tomography - methods; Predictive Value of Tests; Prospective Studies; Radiopharmaceuticals; Risk Factors; Rubidium Radioisotopes; Stroke Volume; Time Factors; Treatment Outcome; Ventricular Function, Left; positron emission tomography; heart transplantation; prognosis
• ISSN: 1941-9651; 1942-0080
• DOI: 10.1161/circimaging.114.002184

Cardiac allograft vasculopathy is a key prognostic determinant after heart transplant. Detection and risk stratification of patients with cardiac allograft vasculopathy are problematic. Positron emission tomography using rubidium-82 allows quantification of absolute myocardial blood flow and may have utility for risk stratification in this population.
Patients with a history of heart transplant undergoing dipyridamole rubidium-82 positron emission tomography were prospectively enrolled. Myocardial perfusion and left ventricular ejection fraction were recorded. Absolute flow quantification at rest and after dipyridamole stress as well as the ratio of mean global flow at stress and at rest, termed myocardial flow reserve, were calculated. Patients were followed for all-cause death, acute coronary syndrome, and heart failure hospitalization. A total of 140 patients (81% men; median age, 62 years; median follow-up, 18.2 months) were included. There were 14 events during follow-up (9 deaths, 1 acute coronary syndrome, and 4 heart failure admissions). In addition to baseline clinical variables (estimated glomerular filtration rate, previously documented cardiac allograft vasculopathy), relative perfusion defects, mean myocardial flow reserve, and mean stress myocardial blood flow were significant predictors of adverse outcome.
Abnormalities on rubidium-82 positron emission tomography were predictors of adverse events in heart transplant patients. Larger prospective studies are required to confirm these findings.