评估 82Rb 正电子发射断层扫描心肌血流定量在心脏移植血管病监测中的应用。
Validation of multiparametric rubidium-82 PET myocardial blood flow quantification for cardiac allograft vasculopathy surveillance.
机构信息
Division of Cardiology, Heart Failure and Transplantation, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y 4W7, Canada.
Division of Cardiology, Interventional Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada.
出版信息
J Nucl Cardiol. 2021 Oct;28(5):2286-2298. doi: 10.1007/s12350-020-02038-y. Epub 2020 Jan 28.
BACKGROUND
We previously demonstrated high diagnostic accuracy of Rubidium-82 positron emission tomography (PET) myocardial blood flow (MBF) quantification for CAV. The purpose of this study was to validate multiparametric PET detection of CAV by combined rate-pressure-product-corrected myocardial flow reserve (cMFR), stress MBF, and coronary vascular resistance (CVR) assessment.
METHODS AND RESULTS
Diagnostic CAV cut-offs of cMFR < 2.9, stress MBF < 2.3, CVR > 55 determined in a previous study (derivation) were assessed in heart transplant recipients referred for coronary angiography and intravascular ultrasound (IVUS) (validation). CAV was defined as International Society of Heart and Lung Transplantation CAV on angiography; and maximal intimal thickness ≥ 0.5 mm on IVUS. Eighty patients (derivation n = 40, validation n = 40) were included: 80% male, mean age 54±14 years, 4.5±5.6 years post transplant. The prevalence of CAV was 44% on angiography and 78% on IVUS. Combined PET cMFR < 2.9, stress MBF < 2.3, CVR > 55 CAV assessment yielded high 88% (specificity 75%) and 83% (specificity 40%) sensitivity for ≥ 1 abnormal parameter and high 88% (sensitivity 59%) and 90% (sensitivity 43%) specificity for 3 abnormal parameters, in the derivation and validation cohorts, respectively.
CONCLUSION
We validate the diagnostic accuracy of multiparametric PET flow quantification by cMFR, stress MBF, and CVR for CAV.
背景
我们之前已经证明了锶-82 正电子发射断层扫描（PET）心肌血流（MBF）定量对 CAV 的高诊断准确性。本研究的目的是通过联合应用校正后的压力-乘积-校正心肌血流储备（cMFR）、应激 MBF 和冠状动脉阻力（CVR）评估来验证多参数 PET 对 CAV 的检测。
方法和结果
在之前的研究（推导）中确定的 cMFR<2.9、应激 MBF<2.3、CVR>55 的诊断 CAV 切点在心脏移植受者中进行了评估，这些受者因冠状动脉造影和血管内超声（IVUS）而转诊（验证）。CAV 定义为血管造影上的国际心肺移植学会 CAV；和 IVUS 上的最大内膜厚度≥0.5mm。80 例患者（推导 n=40，验证 n=40）纳入研究：男性占 80%，平均年龄 54±14 岁，移植后 4.5±5.6 年。血管造影上 CAV 的患病率为 44%，IVUS 上为 78%。联合 PET cMFR<2.9、应激 MBF<2.3、CVR>55 的 CAV 评估在推导和验证队列中，对≥1 个异常参数的检测具有高的 88%（特异性 75%）和 83%（特异性 40%）敏感性，对 3 个异常参数的检测具有高的 88%（敏感性 59%）和 90%（敏感性 43%）特异性。
结论
我们验证了通过 cMFR、应激 MBF 和 CVR 对 CAV 的多参数 PET 流量定量的诊断准确性。
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