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

Jögi, Jonas LU ; 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
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
Elsevier Inc.
external identifiers
  • scopus:85054087466
ISSN
1551-7136
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
2019-03-19 04:00:36
@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         = {1551-7136},
  keyword      = {Heart failure,Lung scintigraphy,Pulmonary congestion,Pulmonary perfusion distribution,Right heart catheterization,V/P SPECT},
  language     = {eng},
  number       = {5},
  pages        = {902--910},
  publisher    = {Elsevier 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},
  volume       = {5},
  year         = {2018},
}