Key result
CZT SPECT using 201 Tl or 99m Tc tracers accurately detected moderate-to-severe cardiac allograft vasculopathy, comparable to 13 N-NH 3 PET (CZT AUC 0.90; 95% CI 0.70-0.99).
Why the study?
Cardiac allograft vasculopathy is the leading cause of long-term mortality after heart transplantation, but the diagnostic performance of 99mTc and 201Tl dynamic CZT SPECT for myocardial blood flow quantification needed validation against 13N-NH3 PET.
Does CZT SPECT with 99mTc or 201Tl tracers accurately quantify myocardial blood flow and flow reserve compared to 13N-NH3 PET for detecting cardiac allograft vasculopathy in heart transplant patients?
Observational (n=38)
Does CZT SPECT with 99mTc or 201Tl tracers accurately quantify myocardial blood flow and flow reserve compared to 13N-NH3 PET for detecting cardiac allograft vasculopathy in heart transplant patients?
Effect estimate: AUC 0.90 (95% CI 0.70-0.99)
CZT SPECT using 201Tl or 99mTc tracers provides comparable myocardial blood flow and flow reserve quantification to 13N-NH3 PET for detecting cardiac allograft vasculopathy in heart transplant patients.
Background: Cardiac allograft vasculopathy (CAV) is an obliterative and diffuse form of vasculopathy and is the most common cause of long-term cardiovascular mortality in heart transplant patients. This study aimed to investigate the diagnostic performance of 99m Tc and 201 Tl tracers in the assessment of CAV using cadmium-zinc-telluride (CZT) single-photon emission computed tomography (SPECT) for myocardial blood flow (MBF) and myocardial flow reserve (MFR) quantification, which was further validated using 13 N-NH 3 positron emission tomography (PET). Methods: Thirty-eight patients with prior heart transplantation who underwent CZT SPECT and 13 N-NH 3 PET dynamic scans were included in this study. CZT SPECT with 99m Tc-sestamibi was used in the first 19 patients and 201 Tl-chloride for the remaining patients. To determine the diagnostic accuracy of angiographically defined moderate-to-severe CAV, the analysis included patients who underwent angiographic examinations within 1 year of their second scan. Results: There were no significant differences in the patient characteristics between the 201 Tl and 99m Tc tracer groups. Both 201 Tl and 99m Tc CZT SPECT-derived stress MBF and MFR values globally and in 3 coronary territories showed good correlations with 13 N-NH 3 PET. The 201 Tl and 99m Tc cohorts did not differ significantly in the correlation coefficients of CZT SPECT versus PET for MBF and MFR, except for stress MBF ( 201 Tl:0.95 versus 99m Tc:0.80, P =0.03). 201 Tl and 99m Tc CZT SPECT were satisfactory for detecting PET MFR <2.0 ( 201 Tl area under the curve, 0.92 [0.71–0.99], 99m Tc area under the curve, 0.87 [0.64–0.97]) and angiographically defined moderate-to-severe CAV, and CZT SPECT results were comparable to that of 13 N-NH 3 PET (CZT area under the curve, 0.90 [0.70–0.99], PET area under the curve, 0.86 [0.64–0.97]). Conclusions: This small study suggests that CZT SPECT using 201 Tl and 99m Tc tracers showed comparable MBF and MFR, and the results correlated well with those of 13 N-NH 3 PET. Hence, CZT SPECT with 201 Tl or 99m Tc tracers can be used to detect moderate-to-severe CAV in patients with prior heart transplantation. However, validation using larger studies is warranted.
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Ko et al. (2023) conducted an observational in Cardiac allograft vasculopathy (n=38). CZT SPECT with 201 Tl or 99m Tc tracers vs. 13 N-NH 3 PET was evaluated on Detection of angiographically defined moderate-to-severe CAV (AUC 0.90, 95% CI 0.70-0.99). CZT SPECT using 201 Tl or 99m Tc tracers accurately detected moderate-to-severe cardiac allograft vasculopathy, comparable to 13 N-NH 3 PET (CZT AUC 0.90; 95% CI 0.70-0.99).
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