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Cardiac allograft vasculopathy (CAV) is common among orthotopic heart transplant (OHT) recipients and a major factor leading to mortality. We examined to what extent serial myocardial perfusion imaging (MPI) is useful diagnostically and prognostically, in terms of time course and eventual outcomes.
Using the OHT and MPI electronic databases at a single center, 192 patients were identified who had undergone OHT and serial MPI's between January 1, 2000 and December 31, 2011. Collected data included gender, age, diabetes, hyperlipidemia, hypertension, smoking, family history of premature CAD and time to an abnormal MPI (AMPI) defined by a summed stress score > 3. Average time to an event including death from any cause or a cardiovascular event (coronary revascularization, myocardial infarction, retransplantation or stroke) was calculated. Events were abstracted from patient charts and the Social Security Death Index.
The 192 OHT patients underwent 801 MPI's over a mean follow up period of 5.6 (+ 2.7) years. 54 patients (28%) ultimately developed an AMPI. Of these 54 patients, 11% (6 patients) had an AMPI by 1 year, 78% (42 patients) by 5 years, and 93% (50 patients) by 7 years. The average time to AMPI was 6 years. Traditional risk factor data did not differ between those with and without AMPI. Over a mean follow up period of 3.3 years (+1.5) after AMPI, 7 of 54 patients with AMPI's (13%) experienced a cardiovascular event or death. Mean time from AMPI to event was 2.4 years (+1.5) and mean time from OHT to event was 6.8 years (+3.5).
Serial MPI is helpful in identifying CAV and patients at risk for adverse outcomes following OHT. Many convert to abnormality early following OHT and events may occur soon after AMPI. Traditional risk factors are not predictive of early post-transplant cardiac allograft vasculopathy.
Poster Sessions, Expo North
Sunday, March 10, 2013, 9:45 a.m.-10:30 a.m.
Session Title: SPECT: Appropriate Use Criteria and Role in Specific Populations
Abstract Category: 21. Imaging: Nuclear
Presentation Number: 1229-362
- 2013 American College of Cardiology Foundation