Diagnostic and prognostic value of myocardial perfusion gated SPECT in orthotopic heart transplant recipients.
BACKGROUND
Cardiac allograft vasculopathy (CAV) limits long-term survival after heart transplantation. Diagnostic and prognostic value of gated single photon emission computed tomography (gated SPECT) has not been documented in this setting.


RESULTS
We identified 110 consecutive heart transplant recipients (with transplantation >18 months) who underwent stress-rest gated SPECT and coronary angiography within 1 month, and were clinically monitored in a single heart transplantation center. Visual scoring of perfusion and wall motion images used a 16-segment model. Left ventricular function was automatically calculated. Coronary angiography was normal in 64 patients (58%) and abnormal in 46 (any CAV, 42%), of whom 19 had severe stenoses. Sensitivity and negative predictive (NPV) value were .63 and .75 for identification of any CAV, and .84 and .96 for severe CAV. Cox regression analysis showed that independent predictors of cardiac death and retransplantation were the presence of any angiographic CAV lesions (RR = 8.816, P = .043) and a stress perfusion defect >3 segments (RR = 5.607, P = .0053). A stress perfusion defect >3 segments predicted the need for late coronary revascularization >2 months (RR = 6.11, P = .0002).


CONCLUSIONS
We conclude that perfusion gated SPECT is a useful noninvasive screening test and may be proposed to help identify heart transplant recipients with a high risk of poor clinical outcome. A normal gated SPECT was associated with a low risk of cardiac hard event and might alleviate the need for coronary angiography.
Manrique
Alain
A
Department of Nuclear Medicine, Rouen University Hospital, Henri Becquerel Center, Rouen, France. manrique@cyceron.fr
Bernard
Mathieu
M
Hitzel
Anne
A
Bubenheim
Michael
M
Tron
Christophe
C
Agostini
Denis
D
Cribier
Alain
A
Véra
Pierre
P
Bessou
Jean Paul
JP
Redonnet
Michel
M
D000328:Adult; D000368:Aged; D017023:Coronary Angiography / Q000379:methods; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging* / Q000503:physiopathology; D016027:Heart Transplantation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology*; D010477:Perfusion; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*; D016896:Treatment Outcome; D016277:Ventricular Function, Left