Can T1-201 myocardial SPECT abnormalities in orthotopic heart recipients be explained by coronary vessel wall alterations assessed by intravascular ultrasound?

Kerber, Sebastian; Puschkas, C.; Jonas, M.; Janssen, Françoise; Heinemann-Vechtel, O; Kosch, Markus; Deng, Mario C.; Schober, Otmar; Scheld, Hans H.; Breithardt, Günter

doi:10.1016/s0167-5273(96)02777-5

Cited by 6 publications

(4 citation statements)

References 13 publications

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“…The distribution of abnormalities could be explained by the diffuse nature of small vessel alterations and also former cellular rejections effects. We [13] and other investigators [11, 12] have found the progressive increase in inhomogeneity score with time, whereas the severity of 201 Tl myocardial perfusion abnormalities did not correlate the IVUS findings [11, 12]. Recently, the lack of correlation between intracoronary Doppler measurements and progression of CAV was also documented [28].…”

Section: Discussionmentioning

confidence: 77%

“…On 201 Tl myocardial perfusion SPECT, inhomogeneous pathological patterns including reversible, fixed perfusion defects or reverse redistribution are frequently noted. Several studies have found the progressive heterogeneity of myocardial perfusion after transplantation [11,12,13]. The progressive perfusion abnormalities may be caused by small vessel alternations.…”

Section: Introductionmentioning

confidence: 99%

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Usefulness of Progressive Inhomogeneity of Myocardial Perfusion and Chronotropic Incompetence in Detecting Cardiac Allograft Vasculopathy: Evaluation with Dobutamine Thallium-201 Myocardial SPECT

Yen²,

Lee³

et al. 2005

Cardiology

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Background: The aim of the study was to investigate the value of longitudinal follow-up of dobutamine thallium-201 single photon emission tomography (²⁰¹Tl SPECT) in the development of significant cardiac allograft vasculopathy (CAV) after orthotopic heart transplantation. Methods: We studied 38 cardiac recipients (mean age 57 ± 12 years) who underwent at least two follow-up dobutamine ²⁰¹Tl SPECT since January 1998. All patients had normal coronary angiography and normal left ventricular function initially. Results: After 2.3 ± 1.8 years, 12 patients developed significant CAV and there were 4 cardiac deaths (1 died suddenly). Of the 99 scans retrospectively analyzed, patients with significant CAV had elevated values of inhomogeneity score, lung/heart ratio (LHR) at stress and lower left ventricular ejection fraction (all p < 0.05). The higher values of inhomogeneity were significantly correlated with higher stress LHR (r = 0.301, p = 0.021), and lower ejection fraction (r = –0.379, p < 0.001). Progressive inhomogeneity was noted in all heart recipients, and more rapid, although statistically insignificant, in patients who developed significant CAV. Ten patients had inadequate chronotropic response to dobutamine infusion up to 40 µg/kg/min in the follow-up studies. The late onset of chronotropic incompetence was an independent predictor of CAV development (p = 0.03). Conclusions: Progressive inhomogeneity of myocardial perfusion, higher lung uptake at stress and chronotropic incompetence assessed by dobutamine ²⁰¹Tl myocardial SPECT provide incremental diagnostic value in detecting significant CAV.

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Section: Discussionmentioning

confidence: 77%

Section: Introductionmentioning

confidence: 99%

Usefulness of Progressive Inhomogeneity of Myocardial Perfusion and Chronotropic Incompetence in Detecting Cardiac Allograft Vasculopathy: Evaluation with Dobutamine Thallium-201 Myocardial SPECT

Yen²,

Lee³

et al. 2005

Cardiology

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“…Apart from the presence of ischemia or scarring, a frequent finding in MPI of heart transplant recipients is inhomogeneous myocardial perfusion in angiographically normal patients [ 12 ]. Previous studies showed that inhomogeneous myocardial perfusion is rare within the first year after transplantation but more frequently observed over time [ 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

“…Even when performed with IVUS, coronary angiography did not detect any kind of CAV in patients presenting with inhomogeneous myocardial perfusion pattern [ 15 ]. Thus, perfusion inhomogeneity is assumed to reflect microvasculopathy which is not detectable by angiography [ 12 , 15 ], although this hypothesis has not been proven so far. Despite these correlative findings, the prognostic relevance of inhomogeneneity in MPI of heart transplant recipients remains unclear.…”

Section: Introductionmentioning

confidence: 99%

Inhomogeneous myocardial stress perfusion in SPECT studies predicts future allograft dysfunction in heart transplant recipients

et al. 2015

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BackgroundMyocardial perfusion gated single photon emission computed tomography (SPECT) can be used for non-invasive detection of coronary artery stenosis and cardiac allograft vasculopathy (CAV), which is a crucial factor for the long-term survival of heart transplant (HTx) recipients. A frequently observed finding in myocardial perfusion imaging of patients after HTx is inhomogeneous myocardial perfusion. This finding is not associated with epicardial CAV, but its prognostic relevance is unclear so far. We therefore evaluated the prognosis of patients with homogeneous versus inhomogeneous myocardial stress perfusion.MethodsOne hundred four HTx patients (mean 3.6 ± 2.9 years after HTx) without significant stress-induced ischemia (summed stress score ≤3) in gated SPECT and without CAV were included. Myocardial stress perfusion was visually assessed as homogeneous, moderately, or severely inhomogeneous. The mean follow-up period after SPECT was 9.4 ± 3.1 years. End points were the diagnosis of CAV, major cardiac events (MACE) or death, and the development of allograft dysfunction (left ventricular ejection fraction, LVEF <45 %).ResultsOf all HTx patients, 24 % enrolled in this study (n = 25) presented with inhomogeneous myocardial perfusion. Compared to the patients with homogeneous perfusion, these patients were at higher risk for developing allograft dysfunction (multivariate hazard ratio, HR = 5.59). As to the development of CAV, the occurrence of MACE, or death, no statistical differences were observed between patients with homogenous and inhomogeneous perfusion. There was no correlation between myocardial perfusion pattern and prior cardiac allograft rejections.ConclusionsInhomogeneous myocardial stress perfusion in SPECT studies predicts a higher risk for future development of allograft dysfunction in HTx patients (LVEF <45 %) but is not associated with future CAV, MACE, or overall survival.

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Microvascular Endothelial Dysfunction after Heart Transplantation

Vassalli¹,

Gallino²

1999

Developments in Cardiovascular Medicine

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Can T1-201 myocardial SPECT abnormalities in orthotopic heart recipients be explained by coronary vessel wall alterations assessed by intravascular ultrasound?

Cited by 6 publications

References 13 publications

Usefulness of Progressive Inhomogeneity of Myocardial Perfusion and Chronotropic Incompetence in Detecting Cardiac Allograft Vasculopathy: Evaluation with Dobutamine Thallium-201 Myocardial SPECT

Usefulness of Progressive Inhomogeneity of Myocardial Perfusion and Chronotropic Incompetence in Detecting Cardiac Allograft Vasculopathy: Evaluation with Dobutamine Thallium-201 Myocardial SPECT

Inhomogeneous myocardial stress perfusion in SPECT studies predicts future allograft dysfunction in heart transplant recipients

Microvascular Endothelial Dysfunction after Heart Transplantation

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