Diagnostic and prognostic value of dobutamine thallium-201 single-photon emission computed tomography after heart transplantation
Journal
Journal of Heart and Lung Transplantation
Journal Volume
24
Journal Issue
5
Pages
544-550
Date Issued
2005
Author(s)
Abstract
Background: Cardiac allograft vasculopathy (CAV) is a major cause of mortality in heart transplant recipients. We investigated the diagnostic and prognostic value of dobutamine thallium-201 (201Tl) single-photon emission computed tomography (SPECT) in heart transplant recipients. Methods: We studied 47 patients (age 51.6 ± 11.7 years, 37 men), at a mean of 34.0 ± 21.4 months after heart transplant, who received dobutamine 201Tl SPECT, echocardiography and coronary angiography within 1 month of each other. SPECT was considered abnormal in the presence of reversible or fixed defects in ?2 segments. Significant CAV was defined as ?50% luminal stenosis. Results: Coronary angiograms were normal in 37 patients. Non-significant CAV was detected in 1 patient and significant CAV in 9 patients. The sensitivity, specificity, positive predictive value and negative predictive value of SPECT for the detection of significant angiographic CAV were 89%, 71%, 42% and 96%, respectively. Large reversible perfusion defects (?6 segments) always indicated significant CAV. In patients with normal left ventricular function, a lung/heart ratio (LHR) of ?0.37 during stress was also an independent predictor of significant CAV (odds ratio 15.5, p = 0.04). A higher stress LHR was associated with greater vessel involvement (r = 0.516, p = 0.0002). Patients with impaired left ventricular function also had higher stress and resting LHR. Over 40.3 ± 21.9 months after the first SPECT, 1 patient developed significant angiographic CAV and another 4 had cardiac death. Large reversible perfusion defect was a significant predictor of cardiac death (p = 0.002). Conclusions: Dobutamine 201Tl SPECT is a useful method for detecting patients with significant CAV and assessing prognosis. It is reasonable and safe to design individualized surveillance intensity of coronary angiography for post-transplant patients on the basis of non-invasive monitoring of dobutamine 201Tl testing. Copyright ? 2005 by the International Society for Heart and Lung Transplantation.
SDGs
Other Subjects
dobutamine; thallium 201; tracer; adult; angiocardiography; article; cardiac allograft vasculopathy; clinical article; controlled study; coronary artery obstruction; diagnostic accuracy; diagnostic imaging; diagnostic value; echocardiography; female; follow up; heart death; heart left ventricle failure; heart left ventricle function; heart perfusion; heart stress; heart transplantation; human; male; prediction; priority journal; prognosis; recipient; reliability; single photon emission computer tomography; Adult; Cardiotonic Agents; Dobutamine; Female; Heart Diseases; Heart Transplantation; Humans; Male; Middle Aged; Predictive Value of Tests; Prognosis; Radiopharmaceuticals; Thallium Radioisotopes; Tomography, Emission-Computed, Single-Photon
Type
journal article