SERIAL RUBIDIUM-82 CARDIAC PET IMAGING EARLY POST HEART TRANSPLANT PREDICTS ADVERSE CARDIOVASCULAR OUTCOMES
CCC ePoster Library. Almufleh A. 10/26/19; 280525; 290
Dr. Aws Almufleh
Dr. Aws Almufleh
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Abstract
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BACKGROUND: Myocardial blood flow (MBF) quantification by Rubidium-82 (Rb82) positron emission tomography (PET) has shown utility for cardiac allograft vasculopathy surveillance and cardiovascular risk stratification post heart transplantation (HT). The objective of this study was to determine the prognostic value of serial Rubidium-82 PET examinations performed early after HT.

METHODS AND RESULTS: A retrospective review was performed of HT recipients with ≥2 PET examinations (PET1=baseline, PET2=follow-up) within the first 5 years of HT. Evaluation of PET flow quantification included stress MBF, coronary vascular resistance (CVR; stress systolic blood pressure/stress MBF) and myocardial flow reserve (MFR; stress MBF/rest MBF). Abnormal low or high flow quantification were defined by mean values for individual PET stress MBF, CVR and MFR parameters. The primary composite outcome included death, allograft dysfunction and new/progressive CAV. Unadjusted Kaplan-Meir survival analysis was used to determine the association between PET1, PET2 and PET1 to PET2 change in stress MBF, CVR and MFR and the primary outcome. A total of 105 patients (80% male, mean age 56±11 years) with 2 consecutive PET scans (mean 1.2±0.4 and 2.3±0.6 years post HT for baseline PET1 and follow-up PET2, respectively) were evaluated. Over a mean follow-up of 3.2±1.7 years, 18 (17%) patients developed the primary outcome: 2 deaths, 12 new/progressive CAV, 9 allograft dysfunction, 5 heart failure hospitalization, 2 coronary revascularization, 1 myocardial infarction. Clinical characteristics were similar, except for older donor age among patients who developed the primary outcome (Table). Patients who experienced the primary outcome had significantly reduced stress MBF and increased CVR (p < 0.05 for all). There was no significant difference in MFR between the two groups. There was a trend towards lower event-free survival in patients with low stress MBF < 2.1 (p=0.083) and high CVR >72 (p=0.091) on baseline PET1. Persistent abnormal PET1 to PET2 low stress MBF and increased CVR were associated with 2.71 fold (95% CI 1.06 to 6.90) and 3.05 fold (95% CI 1.08 to 8.56) increase in cardiovascular events, respectively (Figure).

CONCLUSION: Low stress MBF and increased CVR on serial Rb82 PET imaging early post HT are associated with adverse cardiovascular outcomes. Longitudinal assessment by Rb82 PET may identify at-risk patients for increased surveillance post HT.
BACKGROUND: Myocardial blood flow (MBF) quantification by Rubidium-82 (Rb82) positron emission tomography (PET) has shown utility for cardiac allograft vasculopathy surveillance and cardiovascular risk stratification post heart transplantation (HT). The objective of this study was to determine the prognostic value of serial Rubidium-82 PET examinations performed early after HT.

METHODS AND RESULTS: A retrospective review was performed of HT recipients with ≥2 PET examinations (PET1=baseline, PET2=follow-up) within the first 5 years of HT. Evaluation of PET flow quantification included stress MBF, coronary vascular resistance (CVR; stress systolic blood pressure/stress MBF) and myocardial flow reserve (MFR; stress MBF/rest MBF). Abnormal low or high flow quantification were defined by mean values for individual PET stress MBF, CVR and MFR parameters. The primary composite outcome included death, allograft dysfunction and new/progressive CAV. Unadjusted Kaplan-Meir survival analysis was used to determine the association between PET1, PET2 and PET1 to PET2 change in stress MBF, CVR and MFR and the primary outcome. A total of 105 patients (80% male, mean age 56±11 years) with 2 consecutive PET scans (mean 1.2±0.4 and 2.3±0.6 years post HT for baseline PET1 and follow-up PET2, respectively) were evaluated. Over a mean follow-up of 3.2±1.7 years, 18 (17%) patients developed the primary outcome: 2 deaths, 12 new/progressive CAV, 9 allograft dysfunction, 5 heart failure hospitalization, 2 coronary revascularization, 1 myocardial infarction. Clinical characteristics were similar, except for older donor age among patients who developed the primary outcome (Table). Patients who experienced the primary outcome had significantly reduced stress MBF and increased CVR (p < 0.05 for all). There was no significant difference in MFR between the two groups. There was a trend towards lower event-free survival in patients with low stress MBF < 2.1 (p=0.083) and high CVR >72 (p=0.091) on baseline PET1. Persistent abnormal PET1 to PET2 low stress MBF and increased CVR were associated with 2.71 fold (95% CI 1.06 to 6.90) and 3.05 fold (95% CI 1.08 to 8.56) increase in cardiovascular events, respectively (Figure).

CONCLUSION: Low stress MBF and increased CVR on serial Rb82 PET imaging early post HT are associated with adverse cardiovascular outcomes. Longitudinal assessment by Rb82 PET may identify at-risk patients for increased surveillance post HT.
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