Reduced Myocardial Flow Reserve by Positron Emission Tomography Predicts Cardiovascular Events After Cardiac Transplantation

Matthew C. Konerman; John J. Lazarus; Richard L. Weinberg; Ravi V. Shah; Michael Ghannam; Scott L. Hummel; James R. Corbett; Edward P. Ficaro; Keith D. Aaronson; Monica M. Colvin; Todd M. Koelling; Venkatesh L. Murthy

doi:10.1161/CIRCHEARTFAILURE.117.004473

Reduced Myocardial Flow Reserve by Positron Emission Tomography Predicts Cardiovascular Events After Cardiac Transplantation

Matthew C. Konerman^*, John J. Lazarus, Richard L. Weinberg, Ravi V. Shah, Michael Ghannam, Scott L. Hummel, James R. Corbett, Edward P. Ficaro, Keith D. Aaronson, Monica M. Colvin, Todd M. Koelling, Venkatesh L. Murthy

^*Corresponding author for this work

Medicine, Cardiology Division

Research output: Contribution to journal › Article › peer-review

43 Scopus citations

Abstract

Background: We evaluated the diagnostic and prognostic value of quantification of myocardial flow reserve (MFR) with positron emission tomography (PET) in orthotopic heart transplant patients. Methods and Results: We retrospectively identified orthotopic heart transplant patients who underwent rubidium-82 cardiac PET imaging. The primary outcome was the composite of cardiovascular death, acute coronary syndrome, coronary revascularization, and heart failure hospitalization. Cox regression was used to evaluate the association of MFR with the primary outcome. The relationship of MFR and cardiac allograft vasculopathy severity in patients with angiography within 1 year of PET imaging was assessed using Spearman rank correlation and logistic regression. A total of 117 patients (median age, 60 years; 71% men) were identified. Twenty-one of 62 patients (34%) who underwent angiography before PET had cardiac allograft vasculopathy. The median time from orthotopic heart transplant to PET imaging was 6.4 years (median global MFR, 2.31). After a median of 1.4 years, 22 patients (19%) experienced the primary outcome. On an unadjusted basis, global MFR (hazard ratio, 0.22 per unit increase; 95% confidence interval, 0.09-0.50; P<0.001) and stress myocardial blood flow (hazard ratio, 0.48 per unit increase; 95% confidence interval, 0.29-0.79; P=0.004) were associated with the primary outcome. Decreased MFR independently predicted the primary outcome after adjustment for other variables. In 42 patients who underwent angiography within 12 months of PET, MFR and stress myocardial blood flow were associated with moderate-severe cardiac allograft vasculopathy (International Society of Heart and Lung Transplantation grade 2-3). Conclusions: MFR assessed by cardiac rubidium-82 PET imaging is a predictor of cardiovascular events after orthotopic heart transplant and is associated with cardiac allograft vasculopathy severity.

Original language	English (US)
Article number	e004473
Journal	Circulation: Heart Failure
Volume	11
Issue number	6
DOIs	https://doi.org/10.1161/CIRCHEARTFAILURE.117.004473
State	Published - Jun 1 2018

Funding

Dr Murthy is principal investigator for research supported by the National Heart, Lung, and Blood Institute (1R01HL136685), Singulex, and Siemens Medical Imaging. He receives salary support on grant P01CA059827 from the National Cancer Institute. He serves on an advisory board for Ionetix. He owns stock in General Electric and Cardinal Health and stock options in Ionetix. Dr Corbett is the chairman of the board of INVIA; analytic methods utilized were from INVIA in commercially available software. The other authors report no conflicts.

Keywords

heart transplantation
humans
logistic models
myocardial perfusion imaging
positron emission tomography

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine

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10.1161/CIRCHEARTFAILURE.117.004473

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Konerman, M. C., Lazarus, J. J., Weinberg, R. L., Shah, R. V., Ghannam, M., Hummel, S. L., Corbett, J. R., Ficaro, E. P., Aaronson, K. D., Colvin, M. M., Koelling, T. M., & Murthy, V. L. (2018). Reduced Myocardial Flow Reserve by Positron Emission Tomography Predicts Cardiovascular Events After Cardiac Transplantation. Circulation: Heart Failure, 11(6), Article e004473. https://doi.org/10.1161/CIRCHEARTFAILURE.117.004473

@article{75e21eed37ea43e398fca6dbb5145b9a,

title = "Reduced Myocardial Flow Reserve by Positron Emission Tomography Predicts Cardiovascular Events After Cardiac Transplantation",

abstract = "Background: We evaluated the diagnostic and prognostic value of quantification of myocardial flow reserve (MFR) with positron emission tomography (PET) in orthotopic heart transplant patients. Methods and Results: We retrospectively identified orthotopic heart transplant patients who underwent rubidium-82 cardiac PET imaging. The primary outcome was the composite of cardiovascular death, acute coronary syndrome, coronary revascularization, and heart failure hospitalization. Cox regression was used to evaluate the association of MFR with the primary outcome. The relationship of MFR and cardiac allograft vasculopathy severity in patients with angiography within 1 year of PET imaging was assessed using Spearman rank correlation and logistic regression. A total of 117 patients (median age, 60 years; 71% men) were identified. Twenty-one of 62 patients (34%) who underwent angiography before PET had cardiac allograft vasculopathy. The median time from orthotopic heart transplant to PET imaging was 6.4 years (median global MFR, 2.31). After a median of 1.4 years, 22 patients (19%) experienced the primary outcome. On an unadjusted basis, global MFR (hazard ratio, 0.22 per unit increase; 95% confidence interval, 0.09-0.50; P<0.001) and stress myocardial blood flow (hazard ratio, 0.48 per unit increase; 95% confidence interval, 0.29-0.79; P=0.004) were associated with the primary outcome. Decreased MFR independently predicted the primary outcome after adjustment for other variables. In 42 patients who underwent angiography within 12 months of PET, MFR and stress myocardial blood flow were associated with moderate-severe cardiac allograft vasculopathy (International Society of Heart and Lung Transplantation grade 2-3). Conclusions: MFR assessed by cardiac rubidium-82 PET imaging is a predictor of cardiovascular events after orthotopic heart transplant and is associated with cardiac allograft vasculopathy severity.",

keywords = "heart transplantation, humans, logistic models, myocardial perfusion imaging, positron emission tomography",

author = "Konerman, {Matthew C.} and Lazarus, {John J.} and Weinberg, {Richard L.} and Shah, {Ravi V.} and Michael Ghannam and Hummel, {Scott L.} and Corbett, {James R.} and Ficaro, {Edward P.} and Aaronson, {Keith D.} and Colvin, {Monica M.} and Koelling, {Todd M.} and Murthy, {Venkatesh L.}",

note = "Publisher Copyright: {\textcopyright} 2018 American Heart Association, Inc.",

year = "2018",

month = jun,

day = "1",

doi = "10.1161/CIRCHEARTFAILURE.117.004473",

language = "English (US)",

volume = "11",

journal = "Circulation: Heart Failure",

issn = "1941-3289",

publisher = "Lippincott Williams and Wilkins",

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Konerman, MC, Lazarus, JJ, Weinberg, RL, Shah, RV, Ghannam, M, Hummel, SL, Corbett, JR, Ficaro, EP, Aaronson, KD, Colvin, MM, Koelling, TM & Murthy, VL 2018, 'Reduced Myocardial Flow Reserve by Positron Emission Tomography Predicts Cardiovascular Events After Cardiac Transplantation', Circulation: Heart Failure, vol. 11, no. 6, e004473. https://doi.org/10.1161/CIRCHEARTFAILURE.117.004473

TY - JOUR

T1 - Reduced Myocardial Flow Reserve by Positron Emission Tomography Predicts Cardiovascular Events After Cardiac Transplantation

AU - Konerman, Matthew C.

AU - Lazarus, John J.

AU - Weinberg, Richard L.

AU - Shah, Ravi V.

AU - Ghannam, Michael

AU - Hummel, Scott L.

AU - Corbett, James R.

AU - Ficaro, Edward P.

AU - Aaronson, Keith D.

AU - Colvin, Monica M.

AU - Koelling, Todd M.

AU - Murthy, Venkatesh L.

PY - 2018/6/1

Y1 - 2018/6/1

N2 - Background: We evaluated the diagnostic and prognostic value of quantification of myocardial flow reserve (MFR) with positron emission tomography (PET) in orthotopic heart transplant patients. Methods and Results: We retrospectively identified orthotopic heart transplant patients who underwent rubidium-82 cardiac PET imaging. The primary outcome was the composite of cardiovascular death, acute coronary syndrome, coronary revascularization, and heart failure hospitalization. Cox regression was used to evaluate the association of MFR with the primary outcome. The relationship of MFR and cardiac allograft vasculopathy severity in patients with angiography within 1 year of PET imaging was assessed using Spearman rank correlation and logistic regression. A total of 117 patients (median age, 60 years; 71% men) were identified. Twenty-one of 62 patients (34%) who underwent angiography before PET had cardiac allograft vasculopathy. The median time from orthotopic heart transplant to PET imaging was 6.4 years (median global MFR, 2.31). After a median of 1.4 years, 22 patients (19%) experienced the primary outcome. On an unadjusted basis, global MFR (hazard ratio, 0.22 per unit increase; 95% confidence interval, 0.09-0.50; P<0.001) and stress myocardial blood flow (hazard ratio, 0.48 per unit increase; 95% confidence interval, 0.29-0.79; P=0.004) were associated with the primary outcome. Decreased MFR independently predicted the primary outcome after adjustment for other variables. In 42 patients who underwent angiography within 12 months of PET, MFR and stress myocardial blood flow were associated with moderate-severe cardiac allograft vasculopathy (International Society of Heart and Lung Transplantation grade 2-3). Conclusions: MFR assessed by cardiac rubidium-82 PET imaging is a predictor of cardiovascular events after orthotopic heart transplant and is associated with cardiac allograft vasculopathy severity.

AB - Background: We evaluated the diagnostic and prognostic value of quantification of myocardial flow reserve (MFR) with positron emission tomography (PET) in orthotopic heart transplant patients. Methods and Results: We retrospectively identified orthotopic heart transplant patients who underwent rubidium-82 cardiac PET imaging. The primary outcome was the composite of cardiovascular death, acute coronary syndrome, coronary revascularization, and heart failure hospitalization. Cox regression was used to evaluate the association of MFR with the primary outcome. The relationship of MFR and cardiac allograft vasculopathy severity in patients with angiography within 1 year of PET imaging was assessed using Spearman rank correlation and logistic regression. A total of 117 patients (median age, 60 years; 71% men) were identified. Twenty-one of 62 patients (34%) who underwent angiography before PET had cardiac allograft vasculopathy. The median time from orthotopic heart transplant to PET imaging was 6.4 years (median global MFR, 2.31). After a median of 1.4 years, 22 patients (19%) experienced the primary outcome. On an unadjusted basis, global MFR (hazard ratio, 0.22 per unit increase; 95% confidence interval, 0.09-0.50; P<0.001) and stress myocardial blood flow (hazard ratio, 0.48 per unit increase; 95% confidence interval, 0.29-0.79; P=0.004) were associated with the primary outcome. Decreased MFR independently predicted the primary outcome after adjustment for other variables. In 42 patients who underwent angiography within 12 months of PET, MFR and stress myocardial blood flow were associated with moderate-severe cardiac allograft vasculopathy (International Society of Heart and Lung Transplantation grade 2-3). Conclusions: MFR assessed by cardiac rubidium-82 PET imaging is a predictor of cardiovascular events after orthotopic heart transplant and is associated with cardiac allograft vasculopathy severity.

KW - heart transplantation

KW - humans

KW - logistic models

KW - myocardial perfusion imaging

KW - positron emission tomography

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SN - 1941-3289

VL - 11

JO - Circulation: Heart Failure

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Reduced Myocardial Flow Reserve by Positron Emission Tomography Predicts Cardiovascular Events After Cardiac Transplantation

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