Defining the role for PET myocardial blood flow early post cardiac transplant
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,a and Daniel S. Berman, MDb
Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA
Received Aug 13, 2020; accepted Aug 14, 2020 doi:10.1007/s12350-020-02345-4
See related article, https://doi.org/10.10 07/s12350-020-02342-7.
With advances in the care of cardiac transplant patients over the last 50 years, cardiac allograft vasculopathy (CAV) has become an increasingly important long-term complication.1 CAV is the most common indication for re-transplantation in patients who survive at least one year and is a leading cause of graft failure and death in patients who survive at least 3-year posttransplant.2 While many transplant programs perform surveillance invasive coronary angiography (ICA), often with intravascular ultrasound, there is mounting evidence for non-invasive monitoring with positron emission tomography (PET).3–8 PET with myocardial blood flow (MBF) measurement for CAV surveillance has a strong pathophysiologic rationale since it can detect the diffuse epicardial and microvascular disease characteristic of CAV. In this issue, Wiefels et al. evaluated the clinical utility of serial PET myocardial blood flow (MBF) measurements in 121 patients early post-transplant.9 The authors demonstrate that patients with an abnormal stress MBF (defined as \ 2.1) on the baseline PET study and those with persistently elevated coronary vascular resistance (defined as [ 76) were more likely to experience adverse cardiovascular events.9 This study suggests that PET has a clinical role for CAV diagnosis
Reprint requests: Robert J. H. Miller, MD, Department of Cardiac Sciences, University of Calgary, GAA08, 3230 Hospital Drive NW, Calgary, AB T2N 2T9, Canada; robert.miller@alberta healthservices.ca J Nucl Cardiol 1071-3581/$34.00 Copyright Ó 2020 American Society of Nuclear Cardiology.
and risk stratification early post-transplant and also confirms the potential benefits of serial PET measurements. Feher et al. recently demonstrated that serial evaluation of coronary flow reserve (CFR), with abnormal defined as \ 1.5, resulted in a significant reclassification in risk of all-cause mortality.8 Additionally, baseline CFR and change in CFR between PET studies were the only significant predictors of all-cause mortality in multivariable analysis.8 The most important, novel aspect of the study by Wiefels et al. was the early nature of the PET assessments. PET studies were performed at a mean of 1.4 and 2.6 years post-transplant for baseline and follow-up studies, respectively. Previous studies have investigated patients between 4.8 and 12.5 years post-transplant.3–8. Prior to the current study, the utility of PET early posttransplant represented an important knowledge gap because proliferation signal inhibitors (PSI) may be more effective in patients with early CAV. In a prior study of 402 patients post cardiac transplant, transition to PSI in the first two years post-transplant was associated with slowe
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