RT Journal Article
SR Electronic
T1 PET/CT with Myocardial Blood Flow Assessment Is Prognostic of Cardiac Allograft Vasculopathy Progression and Clinical Outcomes
JF Journal of Nuclear Medicine
JO J Nucl Med
FD Society of Nuclear Medicine
SP 264
OP 270
DO 10.2967/jnumed.124.268713
VO 66
IS 2
A1 Prasad, Nikil
A1 Harris, Erin
A1 DeFilippis, Ersilia M.
A1 Sayer, Gabriel
A1 Chernovolenko, Margarita
A1 Colombo, Paolo C.
A1 Fried, Justin
A1 Bae, David
A1 Oh, Kyung Taek
A1 Raikhelkar, Jayant
A1 Kumar, Sambhavi Sneha
A1 Yuzefpolskaya, Melana
A1 Topkara, Veli K.
A1 Castillo, Michelle
A1 Lam, Elaine Y.
A1 Latif, Farhana
A1 Takeda, Koji
A1 Uriel, Nir
A1 Einstein, Andrew J.
A1 Clerkin, Kevin J.
YR 2025
UL http://jnm.snmjournals.org/content/66/2/264.abstract
AB Cardiac allograft vasculopathy (CAV) causes impaired blood flow in both epicardial vessels and microvasculature and remains a leading cause of posttransplant morbidity and mortality. This study examined the prognostic value and outcomes of CAV, assessed by 13N-ammonia PET/CT myocardial perfusion imaging in heart transplant recipients. Methods: PET/CT and invasive coronary angiography (ICA) were graded using validated scales. CAV progression was assessed using intrapatient sequences: baseline ICA, interval PET/CT with myocardial blood flow reserve, and subsequent ICA. Intervals between ICAs of 600, 900, and 1200 d were included, and for each, the negative predictive value (NPV) of CAV development was assessed. Results: In total, 344 heart transplant recipients underwent PET/CT for CAV assessment with a median follow-up of 4.8 y. PET CAV grade 0/1 had an NPV of 0.93, 0.95, and 0.95 at each respective time point for developing an International Society for Heart and Lung Transplantation CAV 2/3 on subsequent ICA. Compared with PET CAV 0, PET CAV 2/3 was associated with a 2.9-fold increased risk of all-cause mortality (hazard ratio, 2.86; 95% CI, 1.36–6.00; P = 0.006). PET CAV 1 had a numerically increased risk (hazard ratio, 2.03; 95% CI, 0.99–4.15; P = 0.054). In a sensitivity analysis of 135 patients with stable International Society for Heart and Lung Transplantation CAV over successive ICA, PET CAV 2/3 remained associated with increased risk of death or retransplantation (hazard ratio, 3.20; 95% CI, 1.18–8.69; P = 0.03). Conclusion: Noninvasive CAV assessment by PET/CT and myocardial blood flow reserve provides prognostic information and robust NPVs for development of moderate to severe CAV over intervals up to 4 y. These data suggest that, for certain patients, intervals between invasive screenings may be extended.