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J Nucl Med. 2012; 53 (Supplement 1):245
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Cardiovascular

Advanced Imaging in Assessment of CAD & Atherosclerosis

Cardiac PET perfusion imaging & coronary angiography findings in heart transplant patients

Bina Franklin1, Arlene Travis1, Sean Pinney1 and Josef Machac1

1 Mount Sinai Medical Center, New York, NY

Abstract No. 245

Objectives: Evaluate the relationship between visual & quantitative PET myocardial perfusion imaging (MPI) and coronary angiography (CA) findings in heart transplant (HTX) patients.

Methods: 14 post HTX pts followed clinically with Rb-82 PET MPI and CA were studied retrospectively. MPI and CA tests done within 6 mos of one another were identified. The pair of tests done furthest from transplant date was evaluated. MPI was analyzed in 17-segment model; segments were grouped into regions (regs) corresponding to coronary circulation: LAD,LCX RCA. Pharmacological stress defects, reversible or fixed at rest, were identified, as were coronary occlusions >50% on CA. CFR was calculated from MPI: normal≥ 2.0. Findings were correlated, contingency tables constructed, chi squared & Fisher’s exact tests were performed

Results: 14 pts(11 male) average age 54 were followed for a mean of 82 mos post HTX. 13 had at least 1 episode of rejection by histology. Abnormal (abn) CA was seen in 28% of studies; abn MPI in 52%, abn global CFR in 52%. Normal (nl) MPI predicted nl CA (NPV=90%) (p=0.00167.) Abn MPI had 83% sensitivity for abn CA but nl CA had nl MPI in only 60% regs. 58% abn CFR was found in regs with abn CA. 75% nl CFR was found in regs with nl CA, but nl CA correlated with nl CFR in only 63% regs. 75% of regs with nl CFR had nl MPI (p=0.0088) and 60% of regs with nl MPI had nl CFR. 50% of regs with abn CFR had nl MPI; 67% regs with abn MPI had abn CFR. Over time MPI defects tended to increase and CFR decreased.

Conclusions: These post HTX patients with at least 1 episode of rejection had a high prevalence of abn MPI and abn CFR, yet lower prevalence of abn CA. Nl regional MPI correlated with nl CA and nl CFR, but abn MPI and abn CFR were frequently present without discrete coronary lesions, and abn CFR was frequently present in regions without abn MPI. This attests to the diffuse nature of Cardiac Allograft Vasculopathy. MPI and CFR may find a role in post HTX surveillance, as nl MPI and nl CFR predicted lack of significant occlusion on CA. Further study of the prognostic values of CA, MPI and CFR is needed





This Article
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Right arrow Articles by Machac, J.