title: Single photon emission computed tomography myocardial perfusion imaging to detect cardiac allograft vasculopathy.
abstract: OBJECTIVE
  Cardiac allograft vasculopathy (CAV) is a major cause of morbidity and mortality in cardiac transplant recipients. This study evaluates the usefulness of single photon emission computed tomography (SPECT) and various SPECT-derived diastolic variables to detect CAV in heart transplant patients.
  
  
  RESULTS
  A retrospective review of 141 SPECT studies with corresponding coronary angiograms within 12 months was performed on 99 transplant recipients. Diastolic function was assessed using computer-derived measures of peak filling rate (PFR), time to peak filling rate (TPFR), and mean first one-third filling rate (MFR/3). Angiography identified CAV in 53 of the 141 studies (38%). Of the 53, SPECT identified 7 with reversible myocardial defects (sensitivity 13%) and stress-induced electrocardiographic evidence of ischaemia was seen in one patient (sensitivity 2%). SPECT imaging was negative in 86 of the 88 negative coronary angiograms (specificity 98%). The positive predictive value and negative predictive value were 78 and 65%, respectively. If a more stringent definition of CAV was used (≥70% stenosis), the sensitivity and specificity were unchanged (14 and 98%, respectively). There was no statistical difference in diastolic variables between patients with or without angiographic evidence of CAV in regard to PFR (3.57 ± 1.14 vs. 3.18 ± 1.21 EDV/s, P = 0.90), TPFR (149 ± 32 vs. 153 ± 43 ms, P = 0.33), or MFR/3 (1.37 ± 0.43 vs. 1.27 ± 0.42 EDV/s, P = 0.94).
  
  
  CONCLUSIONS
  Adenosine stress/rest technetium-99m tetrofosmin-gated SPECT is not a sensitive test for detection of CAV in heart transplant recipients. Diastolic dysfunction, as assessed by SPECT, was not shown to be associated with development of CAV.
authors.affiliation: Division of Cardiology, Department of Medicine, Loyola University Chicago, Stritch School of Medicine, Maywood, IL, USA.
authors.forename: David
authors.initials: D
authors.lastname: Thompson
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Koster
authors.forename: Robert H
authors.initials: RH
authors.lastname: Wagner
authors.forename: Alain
authors.initials: A
authors.lastname: Heroux
authors.forename: John T
authors.initials: JT
authors.lastname: Barron
mesh_terms: D055426:Cardiac-Gated Single-Photon Emission Computer-Assisted Tomography; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000209:etiology; D003971:Diastole; D005260:Female; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014184:Transplantation, Homologous / Q000009:adverse effects