Feasibility of Non-Invasive Screening for Coronary Allograft Vasculopathy with Positron Emission Tomography Derived Myocardial Blood Flow Assessment
Author: Zarina Sharalaya, MD, Additional Authors**
Background:
Recent studies have shown promising data supporting the use of positron emission tomography (PET) in place of the current invasive gold standard, coronary angiography to screen for coronary allograft vasculopathy (CAV). PET can functionally assess flow using myocardial blood flow (MBF) which correlates with CAV and can portend poor outcomes. We sought to determine the ability of PET to identify CAV in comparison to coronary angiography.
Methods:
Retrospectively identified all heart transplant recipients who had regadenoson rubidium-82 PET rest-stress tests and coronary angiography at our institution between November 2012 and March 2019. CAV grade was based on ISHLT criteria according to Figure 1 which is adapted from researchers at Brigham and Women’s Hospital. A cutoff of MBF <1.7 was used in their algorithm which we also applied to our sample.
Limitations:
Limited number of transplant patients who have undergone both PET and coronary angiography in this analysis
Conclusions:
PET appears to be a good screening modality for CAV, as all of those with severe CAV angiographically had at least grade 1 CAV on PET. No adverse events related to ischemia in those with CAV scores of 0 based on PET.
PET should be strongly considered as the primary method of CAV screening in transplant patients after year 3 to avoid the risks of invasive angiography in a particularly delicate population of patients.
**Additional Authors
Zarina Sharalaya, MD, Cleveland Clinic
Andrew Noll, MD, Cleveland Clinic
Paul Cremer, MD, Cleveland Clinic
Randall Starling, MD, Cleveland Clinic
Wilson Tang, MD, Cleveland Clinic
Fellowship Director: Venu Menon, MD, FACC
Fellowship Coordinator: Lois Adamski
