心脏移植血管病中外膜内膜疾病和微血管功能障碍的 PET 评估。
PET Assessment of Epicardial Intimal Disease and Microvascular Dysfunction in Cardiac Allograft Vasculopathy.
机构信息
Heart Failure and Transplantation, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
Interventional Cardiology, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
出版信息
J Am Coll Cardiol. 2018 Apr 3;71(13):1444-1456. doi: 10.1016/j.jacc.2018.01.062.
BACKGROUND
Cardiac allograft vasculopathy (CAV) is a leading cause of graft failure and death after heart transplantation. Absolute myocardial blood flow (MBF) quantification using rubidium 82 (Rb-82) positron emission tomography (PET) could enable evaluation of diagnostically challenging diffuse epicardial and microvascular disease in CAV.
OBJECTIVES
The authors aimed to evaluate Rb-82 PET detection of CAV.
METHODS
Consecutive transplant recipients undergoing coronary angiography were prospectively evaluated with PET, multivessel intravascular ultrasound (IVUS), and intracoronary hemodynamics. CAV was defined as International Society of Heart and Lung Transplantation CAV on angiography and maximal intimal thickness ≥0.5 mm on IVUS.
RESULTS
Forty patients (mean age 56 years, 4.8 years post-transplant) completed evaluation. CAV was detected in 32 patients (80%) by IVUS and 14 (35%) by angiography. PET correlated significantly with invasive coronary flow indices: r = 0.29, rate-pressure product-adjusted myocardial flow reserve (cMFR) versus coronary flow reserve; r = 0.28, relative flow reserve versus fractional flow reserve; and r = 0.37, coronary vascular resistance (CVR) versus index of microcirculatory resistance. Patients with CAV or microvascular dysfunction had reduced cMFR and stress MBF and increased CVR. Receiver operator characteristic curves demonstrated good accuracy of PET for CAV on IVUS (area under the curve 0.77 to 0.81) and optimal diagnostic cutoffs of cMFR <2.9, stress MBF <2.3, and CVR >55. Combined PET assessment for CAV yielded excellent >93% sensitivity (>65% specificity) for 1 abnormal parameter and >96% specificity (>55% sensitivity) for 2 abnormal parameters.
CONCLUSIONS
Rb-82 PET flow quantification has high diagnostic accuracy for CAV, with potential for noninvasive evaluation after heart transplantation.
背景
心脏同种异体移植血管病（CAV）是心脏移植后移植物衰竭和死亡的主要原因。使用放射性铷 82（Rb-82）正电子发射断层扫描（PET）进行绝对心肌血流（MBF）定量可以评估 CAV 中具有挑战性的弥漫性心外膜和微血管疾病。
目的
作者旨在评估 Rb-82 PET 对 CAV 的检测。
方法
连续接受冠状动脉造影的移植受者前瞻性地接受 PET、多血管血管内超声（IVUS）和冠状动脉内血流动力学检查。CAV 定义为血管造影上的国际心肺移植协会 CAV 和 IVUS 上的最大内膜厚度≥0.5mm。
结果
40 例患者（平均年龄 56 岁，移植后 4.8 年）完成了评估。IVUS 检测到 32 例（80%）和血管造影检测到 14 例（35%）患者有 CAV。PET 与有创冠状动脉血流指数显著相关：r=0.29，校正压力-速率乘积的心肌血流储备（cMFR）与冠状动脉血流储备；r=0.28，相对血流储备与血流储备分数；r=0.37，冠状动脉阻力（CVR）与微血管阻力指数。有 CAV 或微血管功能障碍的患者 cMFR 和应激 MBF 降低，CVR 增加。受试者工作特征曲线显示，PET 对 IVUS 上的 CAV 具有良好的准确性（曲线下面积为 0.77 至 0.81），cMFR<2.9、应激 MBF<2.3 和 CVR>55 的最佳诊断截止值。PET 对 CAV 的联合评估对 1 个异常参数的敏感性>93%（特异性>65%），对 2 个异常参数的特异性>96%（敏感性>55%）。
结论
Rb-82 PET 流量定量对 CAV 具有较高的诊断准确性，有可能在心脏移植后进行非侵入性评估。
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