PET/CT with Myocardial Blood Flow Assessment Is Prognostic of Cardiac Allograft Vasculopathy Progression and Clinical Outcomes

作者：Nikil Prasad, Erin Harris, E. Defilippis, G. Sayer, M. Chernovolenko, P. Colombo, Justin A. Fried, David J. Bae, K. T. Oh, J. Raikhelkar, Sambhavi Sneha Kumar, M. Yuzefpolskaya, V. Topkara, M.R. Castillo, Elaine Y. Lam, F. Latif, Koji Takeda, N. Uriel, A. Einstein, K. Clerkin · 发表于：Journal of Nuclear Medicine · 年份：2025 · DOI：10.2967/jnumed.124.268713 · 被引用次数：7 · 研究领域：Medicine

Visual Abstract Cardiac allograft vasculopathy (CAV) causes impaired blood flow in both epicardial vessels and microvasculature and remains a leading cause of posttransplant morbidity and mortality. This study examined the prognostic value and outcomes of CAV, assessed by 13N-ammonia PET/CT myocardial perfusion imaging in heart transplant recipients. Methods: PET/CT and invasive coronary angiography (ICA) were graded using validated scales. CAV progression was assessed using intrapatient sequences: baseline ICA, interval PET/CT with myocardial blood flow reserve, and subsequent ICA. Intervals between ICAs of 600, 900, and 1200 d were included, and for each, the negative predictive value (NPV) of CAV development was assessed. Results: In total, 344 heart transplant recipients underwent PET/CT for CAV assessment with a median follow-up of 4.8 y. PET CAV grade 0/1 had an NPV of 0.93, 0.95, and 0.95 at each respective time point for developing an International Society for Heart and Lung Transplantation CAV 2/3 on subsequent ICA. Compared with PET CAV 0, PET CAV 2/3 was associated with a 2.9-fold increased risk of all-cause mortality (hazard ratio, 2.86; 95% CI, 1.36–6.00; P = 0.006). PET CAV 1 had a numerically increased risk (hazard ratio, 2.03; 95% CI, 0.99–4.15; P = 0.054). In a sensitivity analysis of 135 patients with stable International Society for Heart and Lung Transplantation CAV over successive ICA, PET CAV 2/3 remained associated with increased risk of death or retran...