Feasibility and accuracy of SPECT myocardial perfusion imaging in end-stage lung disease

Coronary artery disease in lung transplant patients

“…Moreover, exercise testing is of little value because exertion tolerance is limited by pulmonary disease, dipyridamole scanning might be a contraindication in severe obstructive lung disease, and dobutamine thallium scanning has limited specificity and unknown sensitivity in this patient population 6,7 . It has been suggested by newer studies, that pharmacological stress testing with single photon emission computer tomography (SPECT‐MPI) using Regadenoson (selective A2A receptor agonist) is well tolerated in patients with end‐stage lung disease and may help to determine which patients should undergo percutaneous coronary interventions (PCI) to mitigate CAD before lung transplant and which ones shouldn't 8 . However, positron emission tomography (PET) myocardial perfusion using rubidium‐82 (the most widely used radionuclide) demonstrates a sensitivity and specificity of 90% and 88% for the detection of obstructive CAD when compared to invasive coronary angiography, with superior accuracy when compared with SPECT.…”

“…6,7 It has been suggested by newer studies, that pharmacological stress testing with single photon emission computer tomography (SPECT-MPI) using Regadenoson (selective A2A receptor agonist) is well tolerated in patients with endstage lung disease and may help to determine which patients should undergo percutaneous coronary interventions (PCI) to mitigate CAD before lung transplant and which ones shouldn't. 8 However, positron emission tomography (PET) myocardial perfusion using rubidium-82 (the most widely used radionuclide) demonstrates a sensitivity and specificity of 90% and 88% for the detection of obstructive CAD when compared to invasive coronary angiography, with superior accuracy when compared with SPECT. Nevertheless, the role of PET on screening patients with lung transplant have not yet been validated and it has limited number of center with availably of this technology.…”

Myocardial perfusion imaging with regadenoson stress in advanced lung disease

“…In the study of Schiopu et al, a total of 14 patients reported symptoms related to regadenoson, but only 2 patients required medical treatment with bronchodilators. 10 Furthermore, clinical exacerbations of the lung disease were not observed after regadenoson administration. Based on this, the authors concluded that regadenoson is well tolerated in end-stage lung disease patients.…”

“…In the present issue of the Journal, Schiopu et al bring their contribution to this matter by assessing the safety and accuracy of single photon emission computerized tomography (SPECT) MPI with regadenoson in patients with end-stage lung disease being considered for lung transplantation. 10 The safety of regadenoson in patients with lung disease has been evaluated in randomized, double-blind, placebo-controlled trials. [11][12][13] The RegCOPD trial studied patients with COPD and showed that there were no differences in the lung function parameters, including forced expiratory volume at 1 second (FEV1) after administration of regadenoson as compared to the placebo group.…”

“…Authors conclude that demonstration of myocardial ischemia by SPECT MPI with regadenoson may be helpful in guiding decisions on revascularization prior to lung transplantation. The study by Schiopu et al 10 is associated with some weaknesses related to the relatively small number of patients with obstructive CAD and retrospective design, such as lack of systematic follow-up of lung function after administration of regadenoson and possible exclusion of some patients with an unstable lung disease. However, the study provides valuable information about the safety profile and feasibility of performing SPECT MPI with regadenoson in patients with advanced lung disease that are being considered for lung transplantation.…”