Author + information
- Attila Feher, MD, PhDa,
- Ajay Srivastava, MDb,
- Michael A. Quail, MD, PhDa,c,
- Nabil E. Boutagy, PhDa,
- Pravien Khanna, MDd,
- Lynn Wilson, RNa,
- Edward J. Miller, MD, PhDa,e,
- Yi-Hwa Liu, PhDa,
- Forrester Lee, MDa and
- Albert J. Sinusas, MDa,e,∗ ()
- aSection of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
- bDivision of Cardiovascular Medicine, Scripps Clinic, La Jolla, California
- cInstitute of Cardiovascular Science, University College London, London, United Kingdom
- dRutgers-Robert Wood Johnson University Hospital, New Brunswick, New Jersey
- eDepartment of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut
- ↵∗Address for correspondence:
Dr. Albert J. Sinusas, Section of Cardiovascular Medicine, Yale University School of Medicine, P.O. Box 208017, Dana 3, New Haven, Connecticut 06520-8017.
Objectives This study aimed to evaluate the long-term prognostic value of serial assessment of coronary flow reserve (CFR) by rubidium Rb 82 (82Rb) positron emission tomography (PET) in heart transplantation (HT) patients.
Background Cardiac allograft vasculopathy is a major determinant of late mortality in HT recipients. The long-term prognostic value of serial CFR quantification by PET imaging in HT patients is unknown.
Methods A total of 89 patients with history of HT (71% men, 7.0 ± 5.7 years post-HT, age 57 ± 11 years) scheduled for dynamic rest and stress (dipyridamole) 82Rb PET between March 1, 2008 and July 31, 2009 (PET-1) were prospectively enrolled in a single-center study. PET myocardial perfusion studies were reprocessed using U.S. Food and Drug Administration–approved software (Corridor 4DM, version 2017) for calculation of CFR. Follow-up PET (PET-2) imaging was performed in 69 patients at 1.9 ± 0.3 years following PET-1. Patients were categorized based on CFR values considering CFR ≤1.5 as low and CFR >1.5 as high CFR.
Results Forty deaths occurred during the median follow-up time of 8.6 years. Low CFR at PET-1 was associated with a 2.77-fold increase in all-cause mortality (95% confidence interval [CI]: 1.34 to 5.74; p = 0.004). CFR decreased over time in patients with follow-up imaging (PET-1: 2.11 ± 0.74 vs. PET-2: 1.81 ± 0.61; p = 0.003). Twenty-five patients were reclassified based on PET-1 and PET-2 (high to low CFR: n = 18, low to high CFR: n = 7). Overall survival was similar in patients reclassified from high to low as patients with low to low CFR, whereas patients reclassified from low to high had similar survival as patients with high to high CFR. In multivariate Cox regression of patients with PET-2, higher baseline CFR (hazard ratio [HR] for a 0.73 unit (one standard deviation) increase: 0.36, 95% CI: 0.16 to 0.82) and reduction in CFR from PET-1 to PET-2 (HR for a 0.79 unit (one standard deviation) decrease: 1.50 to 7.84) were independent predictors of all-cause mortality.
Conclusions Serial assessment of CFR by 82Rb PET independently predicts long-term mortality in HT patients.
- cardiac allograft vasculopathy
- coronary flow reserve
- heart transplantation
- myocardial blood flow
- positron emission tomography
This study was supported by a National Institutes of Health T32 training grant (HL098069 to Dr. Sinusas), by the American Society of Nuclear Cardiology (2009 Nuclear Cardiology Foundation Pilot and Feasibility Award to Dr. Srivastava), and by the British Heart Foundation-Fulbright scholar award (FS/16/28/32327 to Dr. Quail). Dr. Miller is a consultant and for Bracco, Inc. and GE Healthcare, Inc. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received January 16, 2018.
- Revision received August 13, 2018.
- Accepted August 14, 2018.
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