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PET Assessment of Myocardial Perfusion Reserve Inversely Correlates with Intravascular Ultrasound Findings in Angiographically Normal Cardiac Transplant Recipients

¹ National Taiwan University College of Medicine, Taipei, Taiwan; ² Department of Nuclear Medicine, National Taiwan University Hospital, Taipei, Taiwan; ³ Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; and ⁴ Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan

Correspondence: For correspondence or reprints contact: Chii-Ming Lee, Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, No. 7, Chung-Shan South Rd., Taipei, 10002, Taiwan. E-mail: chiiminglee{at}ntu.edu.tw

Cardiac allograft vasculopathy (CAV) is the major determinant of long-term survival after heart transplantation. We aimed to evaluate the efficacy of PET as a noninvasive way to assess the early stages of CAV. Methods: Twenty-seven consecutive patients (20 men and 7 women; mean age ± SD, 46 ± 12 y) who had normal results on coronary angiography and normal left ventricular systolic function (ejection fraction 60%) were enrolled at 2.5 ± 2.1 y after transplantation. Myocardial blood flow (MBF) was assessed using dynamic ¹³N-ammonia PET at rest and during adenosine-induced hyperemia, and myocardial perfusion reserve (MPR) was calculated as the ratio of hyperemic MBF to resting MBF. Regional ¹³N-ammonia PET was assessed using a 5-point scoring system. The intravascular ultrasound (IVUS) measurements for the extent of intimal hyperplasia, including plaque volume index (calculated as [total plaque volume/total vessel volume] x 100%) and maximum area of stenosis, were compared with MPR by linear regression analysis. Results: In 27 angiographically normal cardiac transplant recipients, MBF at rest and during adenosine stress and MPR of the left anterior descending artery distribution correlated strongly with the other 2 coronary artery distribution territories (r 0.97, P < 0.0001). Summed stress score and summed difference score showed a moderate inverse correlation with MPR (r = –0.41 and –0.49, respectively; P < 0.05) but not with IVUS measurements. MPR correlated inversely with plaque volume index (r = –0.40, P < 0.05) but not with maximal luminal stenosis as assessed by IVUS. In addition, MPR and IVUS measurements gradually inversely changed after heart transplantation (all P < 0.05). Conclusion: This study confirms that CAV is a progressive process, diffusely involving the epicardial and microvascular coronary system. Plaque burden as determined by IVUS agrees well with MPR as assessed by PET in recipients with normal coronary angiography results. This finding suggests that dynamic ¹³N-ammonia PET is clinically feasible for the early detection of CAV and can be used as a reliable marker of disease progression.

Key Words: cardiac allograft vasculopathy • transplantation • positron emission tomography • myocardial perfusion quantification

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