Nav: Home

PET imaging offers new insights into post-transplant care for heart patients

March 05, 2020

Myocardial blood flow (MBF) and myocardial flow reserve (MFR) have been identified as accurate indicators for graft failure after cardiac transplantation, according to a new study published in The Journal of Nuclear Medicine. Utilizing positron emission tomography (PET) myocardial perfusion imaging to quantify MBF and MRF, researchers were able to successfully detect patients with cardiac allograft vasculopathy (CAV), the most serious condition facing transplant patients late after their surgery. In addition, researchers found that MFR had a significantly higher accuracy when predicting the overall prognosis for cardiac transplant patients.

Heart transplantation is a definitive therapy for patients with end-stage heart failure and has a median post-transplant survival of more than 13 years. As long-term survival has increased, the prevalence of cardiac diseases, such as CAV, has also grown. CAV accounts for over one-third of deaths in patients who survive at least five years after their heart transplant. It is also the most common indication for re-transplantation in patients who survive one year.

"MBF and MFR have been shown to be useful for diagnosis and prognosis of CAV in a few single-center studies, however, there is no consensus on which marker--stress MBF or MFR--should be applied for these purposes," said Robert J.H. Miller, MD, FRCPC, clinical assistant professor at the University of Calgary in Canada. "In this study, we compared the utility of MBF and MFR, using previously derived thresholds, to provide the external validation required to guide broader clinical implementation."

Ninety-nine cardiac transplant patients who underwent 82Rb PET myocardial perfusion imaging over a five-year period in a single center were included in the study. Quantitative and semi-quantitative analyses were performed and imaging parameters were compared among study participants who died (26 patients) and those who survived (73 patients). Researchers then examined the diagnostic and prognostic accuracy for MBR and MFR in detecting significant CAV.

Results from the study demonstrated that stress MBF, uncorrected MFR and corrected MFR were equivalent in identifying patients with significant CAV. In terms of prognosis, researchers found that uncorrected MFR offered superior discrimination for mortality of all causes compared to stress MBF. Further, the study found that preserved MFR (defined as greater than or equal to 2.0) identified low-risk patients, while the presence of multiple abnormal parameters identified patients at the highest risk.

"PET with routine measures of MBF and MFR has a clear role in patients following cardiac transplantation. This study provides practical information for centers implementing PET for CAV surveillance and will help guide them in implementing these important measurements" noted Miller.
-end-
This study was made available online in August 2019 ahead of final publication in print in February 2020.

The authors of "Comparative Prognostic and Diagnostic Value of Myocardial Blood Flow and Myocardial Flow Reserve After Cardiac Transplantation" include Robert J.H. Miller, Balaji Tamarappoo, Sean Hayes, John D. Friedman, Piotr J. Slomka and Daniel S. Berman, Department of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, California; Osamu Manabe, Department of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, California, and Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan; Jignesh Patel and Jon A. Kobashigawa, Smidt Heart Institute, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.

Please visit the SNMMI Media Center for more information about molecular imaging and precision imaging. To schedule an interview with the researchers, please contact Rebecca Maxey at (703) 652-6772 or rmaxey@snmmi.org. Current and past issues of The Journal of Nuclear Medicine can be found online at http://jnm.snmjournals.org.

About the Society of Nuclear Medicine and Molecular Imaging

The Journal of Nuclear Medicine (JNM) is the world's leading nuclear medicine, molecular imaging and theranostics journal, accessed close to 10 million times each year by practitioners around the globe, providing them with the information they need to advance this rapidly expanding field.

JNM is published by the Society of Nuclear Medicine and Molecular Imaging (SNMMI), an international scientific and medical organization dedicated to advancing nuclear medicine and molecular imaging--precision medicine that allows diagnosis and treatment to be tailored to individual patients in order to achieve the best possible outcomes. For more information, visit http://www.snmmi.org.

This work was supported in part by the Dr. Miriam and Sheldon Adelson Medical Research Foundation. Robert Miller receives funding support from the Arthur J.E. Child Fellowship grant. Daniel Berman and Piotr Slomka participate in software royalties for QPS software at Cedars-Sinai Medical Center.

Society of Nuclear Medicine and Molecular Imaging

Related Transplantation Articles:

A revolutionary new treatment alternative to corneal transplantation
A new approach in ophthalmology that offers a revolutionary alternative to corneal transplantation has just been developed by researchers and clinicians in North America, Europe, and Oceania.
Fewer complications after organ transplantation
A large international study coordinated by University Hospital Regensburg and Charité - Universitätsmedizin Berlin has demonstrated the safety of new cell therapy approaches for use in kidney transplant recipients.
Elderly patients also benefit from kidney transplantation
So far, kidney transplantation has generally not been offered to elderly patients (>75 years) because of the perioperative risks.
New material will allow abandoning bone marrow transplantation
Scientists from the National University of Science and Technology 'MISIS' developed nanomaterial, which will be able to restore the internal structure of bones damaged due to osteoporosis and osteomyelitis.
Fewer medical tests -- timely listing for transplantation
Younger patients would benefit greatly from kidney transplantation. Their expected remaining lifetime may even be doubled by having a transplant.
Uterus transplantation -- ethically just as problematic as altruistic surrogacy
In 2014, the first child to have been gestated in a donated uterus was born.
Advancing transplantation: Hepatitis C-infected organs safe for transplantation when followed by antiviral treatment
Twenty patients at Penn Medicine have been cured of the hepatitis C virus (HCV) following lifesaving kidney transplants from deceased donors who were infected with the disease, according to a study published today in Annals of Internal Medicine.
Transplantation followed by antiviral therapy cured hepatitis C
Twenty patients who received kidneys transplanted from hepatitis C virus (HCV)-infected donors experienced HCV cure, good quality of life, and excellent renal function at one year.
The Journal of Heart and Lung Transplantation: 50 years of heart transplantation progress
This month marks the 50th anniversary of the world's first human heart transplant performed at Groote Schuur Hospital in Cape Town by South African surgeon, Christiaan Barnard.
Older donor lungs should be considered for transplantation
With a scarcity of lungs available for transplantation, the use of lungs from donors older than age 60 has been shown to achieve reasonable outcomes and should be considered as a viable option, according to research published online today in The Annals of Thoracic Surgery.
More Transplantation News and Transplantation Current Events

Trending Science News

Current Coronavirus (COVID-19) News

Top Science Podcasts

We have hand picked the top science podcasts of 2020.
Now Playing: TED Radio Hour

Debbie Millman: Designing Our Lives
From prehistoric cave art to today's social media feeds, to design is to be human. This hour, designer Debbie Millman guides us through a world made and remade–and helps us design our own paths.
Now Playing: Science for the People

#574 State of the Heart
This week we focus on heart disease, heart failure, what blood pressure is and why it's bad when it's high. Host Rachelle Saunders talks with physician, clinical researcher, and writer Haider Warraich about his book "State of the Heart: Exploring the History, Science, and Future of Cardiac Disease" and the ails of our hearts.
Now Playing: Radiolab

Insomnia Line
Coronasomnia is a not-so-surprising side-effect of the global pandemic. More and more of us are having trouble falling asleep. We wanted to find a way to get inside that nighttime world, to see why people are awake and what they are thinking about. So what'd Radiolab decide to do?  Open up the phone lines and talk to you. We created an insomnia hotline and on this week's experimental episode, we stayed up all night, taking hundreds of calls, spilling secrets, and at long last, watching the sunrise peek through.   This episode was produced by Lulu Miller with Rachael Cusick, Tracie Hunte, Tobin Low, Sarah Qari, Molly Webster, Pat Walters, Shima Oliaee, and Jonny Moens. Want more Radiolab in your life? Sign up for our newsletter! We share our latest favorites: articles, tv shows, funny Youtube videos, chocolate chip cookie recipes, and more. Support Radiolab by becoming a member today at Radiolab.org/donate.