Wenning Christian, Vrachimis Alexis, Dell Aquila Angelo, Penning Alvyda, Stypmann Jörg, Schäfers Michael
Department of Nuclear Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, 48149, Münster, Germany.
Department of Thoracic and Cardiovascular Surgery, University Hospital Münster, Münster, Germany.
EJNMMI Res. 2015 Dec;5(1):51. doi: 10.1186/s13550-015-0129-8. Epub 2015 Oct 5.
Myocardial 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.
One 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 %).
Of 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.
Inhomogeneous 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.
心肌灌注门控单光子发射计算机断层扫描（SPECT）可用于冠状动脉狭窄和心脏移植血管病变（CAV）的无创检测，而CAV是心脏移植（HTx）受者长期生存的关键因素。HTx术后患者心肌灌注成像中经常观察到的一个现象是心肌灌注不均匀。这一发现与心外膜CAV无关，但其预后相关性目前尚不清楚。因此，我们评估了心肌应激灌注均匀与不均匀患者的预后。
纳入104例HTx患者（HTx术后平均3.6±2.9年），这些患者在门控SPECT中无明显应激性缺血（应激总分≤3）且无CAV。心肌应激灌注通过视觉评估为均匀、中度或重度不均匀。SPECT检查后的平均随访期为9.4±3.1年。终点指标为CAV诊断、主要心脏事件（MACE）或死亡，以及移植心功能障碍（左心室射血分数，LVEF<45%）的发生。
在所有HTx患者中，本研究纳入的患者中有24%（n=25）存在心肌灌注不均匀。与灌注均匀的患者相比，这些患者发生移植心功能障碍的风险更高（多变量风险比，HR=5.59）。在CAV的发生、MACE或死亡方面，灌注均匀和不均匀的患者之间未观察到统计学差异。心肌灌注模式与既往心脏移植排斥反应之间无相关性。
SPECT研究中不均匀的心肌应激灌注预示着HTx患者未来发生移植心功能障碍（LVEF<45%）的风险更高，但与未来的CAV、MACE或总体生存率无关。
