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

Research output: Contribution to journalArticle

Bibtex

@article{d9d4f3abddc34e749bac93aa2be9614d,
title = "Diagnosing and grading heart failure with tomographic perfusion lung scintigraphy: validation with right heart catheterization",
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 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.",
keywords = "Heart failure, Lung scintigraphy, Pulmonary congestion, Pulmonary perfusion distribution, Right heart catheterization, V/P SPECT",
author = "Jonas J{\"o}gi and Mariam Al-Mashat and G{\"o}ran R{\aa}degran and Marika Bajc and H{\aa}kan Arheden",
year = "2018",
doi = "10.1002/ehf2.12317",
language = "English",
volume = "5",
pages = "902--910",
journal = "Heart Failure Clinics",
issn = "1551-7136",
publisher = "Elsevier Inc.",
number = "5",

}