Diagnosing and grading heart failure with tomographic perfusion lung scintigraphy : validation with right heart catheterization
(2018) In ESC Heart Failure 5(5). p.902-910- Abstract
Aims: Pulmonary congestion remains a diagnostic challenge in patients with heart failure (HF). The recommended method, chest X-ray (CXR), lacks in accuracy, whereas quantitative tomographic lung scintigraphy [ventilation/perfusion single-photon emission computed tomography (V/P SPECT)] has shown promising results but needs independent validation. The aim of this study is to evaluate V/P SPECT as a non-invasive method to assess and quantify pulmonary congestion in HF patients, using right heart catheterization as reference method. The secondary objective was to investigate the performance of V/P SPECT in the clinical setting compared with CXR. Methods and results: Forty-six consecutive patients with HF that were under consideration for... (More)
Aims: Pulmonary congestion remains a diagnostic challenge in patients with heart failure (HF). The recommended method, chest X-ray (CXR), lacks in accuracy, whereas quantitative tomographic lung scintigraphy [ventilation/perfusion single-photon emission computed tomography (V/P SPECT)] has shown promising results but needs independent validation. The aim of this study is to evaluate V/P SPECT as a non-invasive method to assess and quantify pulmonary congestion in HF patients, using right heart catheterization as reference method. The secondary objective was to investigate the performance of V/P SPECT in the clinical setting compared with CXR. Methods and results: Forty-six consecutive patients with HF that were under consideration for heart transplantation were studied prospectively. All participants were examined with V/P SPECT, CXR, and right heart catheterization. Pulmonary artery wedge pressure served as reference method. Quantitative perfusion gradients were derived from V/P SPECT images. Ventilation/perfusion single-photon emission computed tomography images were also assessed both by expert readers and clinical nuclear medicine physicians. Expert readers correctly identified 87% of all patients with an elevated pulmonary artery wedge pressure > 15 mmHg. The average sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for V/P SPECT assessed by the expert readers were 87%, 72%, 85%, and 75%, respectively. In the clinical nuclear medicine setting, V/P SPECT had 87% sensitivity, 63% specificity, 81% PPV, and 71% NPV. Clinically, V/P SPECT outperformed CXR, which had 27% sensitivity, 75% specificity, 67% PPV, and 35% NPV. Conclusions: Ventilation/perfusion single-photon emission computed tomography can be used as a non-invasive method to diagnose and quantify pulmonary congestion in patients with HF and is more accurate than CXR in diagnosing pulmonary congestion in the clinical setting.
(Less)
- author
- Jögi, Jonas LU ; Al-Mashat, Mariam LU ; Rådegran, Göran LU ; Bajc, Marika LU and Arheden, Håkan LU
- organization
- publishing date
- 2018
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Heart failure, Lung scintigraphy, Pulmonary congestion, Pulmonary perfusion distribution, Right heart catheterization, V/P SPECT
- in
- ESC Heart Failure
- volume
- 5
- issue
- 5
- pages
- 9 pages
- publisher
- John Wiley & Sons Inc.
- external identifiers
-
- scopus:85054087466
- pmid:30015395
- ISSN
- 2055-5822
- DOI
- 10.1002/ehf2.12317
- language
- English
- LU publication?
- yes
- id
- d9d4f3ab-ddc3-4e74-9bac-93aa2be9614d
- date added to LUP
- 2018-10-09 12:26:11
- date last changed
- 2024-09-17 04:23:09
@article{d9d4f3ab-ddc3-4e74-9bac-93aa2be9614d, abstract = {{<p>Aims: Pulmonary congestion remains a diagnostic challenge in patients with heart failure (HF). The recommended method, chest X-ray (CXR), lacks in accuracy, whereas quantitative tomographic lung scintigraphy [ventilation/perfusion single-photon emission computed tomography (V/P SPECT)] has shown promising results but needs independent validation. The aim of this study is to evaluate V/P SPECT as a non-invasive method to assess and quantify pulmonary congestion in HF patients, using right heart catheterization as reference method. The secondary objective was to investigate the performance of V/P SPECT in the clinical setting compared with CXR. Methods and results: Forty-six consecutive patients with HF that were under consideration for heart transplantation were studied prospectively. All participants were examined with V/P SPECT, CXR, and right heart catheterization. Pulmonary artery wedge pressure served as reference method. Quantitative perfusion gradients were derived from V/P SPECT images. Ventilation/perfusion single-photon emission computed tomography images were also assessed both by expert readers and clinical nuclear medicine physicians. Expert readers correctly identified 87% of all patients with an elevated pulmonary artery wedge pressure > 15 mmHg. The average sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for V/P SPECT assessed by the expert readers were 87%, 72%, 85%, and 75%, respectively. In the clinical nuclear medicine setting, V/P SPECT had 87% sensitivity, 63% specificity, 81% PPV, and 71% NPV. Clinically, V/P SPECT outperformed CXR, which had 27% sensitivity, 75% specificity, 67% PPV, and 35% NPV. Conclusions: Ventilation/perfusion single-photon emission computed tomography can be used as a non-invasive method to diagnose and quantify pulmonary congestion in patients with HF and is more accurate than CXR in diagnosing pulmonary congestion in the clinical setting.</p>}}, author = {{Jögi, Jonas and Al-Mashat, Mariam and Rådegran, Göran and Bajc, Marika and Arheden, Håkan}}, issn = {{2055-5822}}, keywords = {{Heart failure; Lung scintigraphy; Pulmonary congestion; Pulmonary perfusion distribution; Right heart catheterization; V/P SPECT}}, language = {{eng}}, number = {{5}}, pages = {{902--910}}, publisher = {{John Wiley & Sons Inc.}}, series = {{ESC Heart Failure}}, title = {{Diagnosing and grading heart failure with tomographic perfusion lung scintigraphy : validation with right heart catheterization}}, url = {{http://dx.doi.org/10.1002/ehf2.12317}}, doi = {{10.1002/ehf2.12317}}, volume = {{5}}, year = {{2018}}, }