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Diagnosing and grading heart failure with tomographic perfusion lung scintigraphy : validation with right heart catheterization

Jögi, Jonas LU orcid ; Al-Mashat, Mariam LU ; Rådegran, Göran LU ; Bajc, Marika LU and Arheden, Håkan LU (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.

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author
; ; ; and
organization
publishing date
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
2024-03-18 15:53:24
@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 &gt; 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}},
}