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• W2893774608 abstract "Cardiac allograft vasculopathy (CAV) limits long-term patient survival and graft outcomes after heart transplantation. Early epicardial intimal disease and diffuse epicardial and microvascular coronary involvement in CAV are problematic for noninvasive diagnosis. We have shown impaired myocardial blood flow (MBF) quantification in patients with CAV. The purpose of this study was to determine the accuracy of a novel multiparametric approach using Rubidium-82 positron emission tomography (PET). Consecutive patients referred for coronary angiography were prospectively evaluated with PET, multivessel intravascular ultrasound (IVUS) and intracoronary hemodynamics. PET flow quantification included determination of rate-pressure-product corrected myocardial flow reserve (cMFR; stress MBF/rest MBF), stress MBF, and coronary vascular resistance (CVR; stress systolic blood pressure/stress MBF). CAV was defined by (1) angiography according to International Society of Heart and Lung Transplantation CAV1-3, and (2) IVUS as maximal intimal thickness ≥0.5 mm. Forty patients (31 male, mean age 56±14 years) at 3.2 (interquartile range: 1.0, 5.2) median years post-transplant were evaluated with PET and invasive studies 17.2±13.8 mean days apart. The angiography indication was CAV surveillance for 29 patients. CAV was present in 32 (80%) patients by IVUS and 14 by angiography (9 (23%) CAV1, 2 (5%) CAV2, 3 (8%) CAV3). Microvascular dysfunction (intracoronary index of microcirculatory resistance ≥20) was evident in 21 (53%) patients and occurred independently of epicardial disease. Compared to patients without CAV, patients with CAV had significantly reduced cMFR (2.6±1.1 versus 3.8±1.1), reduced stress MBF (1.8±0.6 versus 2.6±0.9), and increased CVR (82±29 versus 54±29) (all p <0.02). Receiver operator characteristic curve analysis demonstrated good ability of cMFR, stress MBF and CVR to detect CAV: area under curve (AUC) 0.71, 0.83, 0.74 for angiographic CAV2-3 and 0.77, 0.78, 0.81 for CAV on IVUS, respectively. Optimal diagnostic cut-offs for CAV were: cMFR <2.9, stress MBF <2.3, CVR >55. Combined PET assessment for CAV yielded >93% sensitivity (>65% specificity) for 1 abnormal parameter and >96% specificity (>55% sensitivity) for two abnormal parameters. All three parameters were included in logistic regression analyses, generating a high-performance multiparametric PET scoring model: AUC 0.76 and 0.85 for angiographic and IVUS defined CAV, respectively (Figure). This model had high 84% sensitivity and 88% specificity for detecting CAV on IVUS. Multiparametric PET cMFR, stress MBF and CVR flow quantification detects CAV with high accuracy, suggesting utility to identify high risk patients for invasive coronary evaluation post-transplant. Our PET score model will be validated in ongoing prospective studies." @default.
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• W2893774608 date "2018-10-01" @default.
• W2893774608 modified "2023-10-16" @default.
• W2893774608 title "MULTIPARAMETRIC RUBIDIUM-82 POSITRON EMISSION TOMOGRAPHY MYOCARDIAL BLOOD FLOW QUANTIFICATION ASSESSMENT OF CARDIAC ALLOGRAFT VASCULOPATHY" @default.
• W2893774608 doi "https://doi.org/10.1016/j.cjca.2018.07.309" @default.
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