Open AccessDiagnosing and grading heart failure with tomographic perfusion lung scintigraphy: validation with right heart catheterization
Author(s) -
Jögi Jonas,
AlMashat Mariam,
Rådegran Göran,
Bajc Marika,
Arheden Håkan
Publication year - 2018
Publication title -
esc heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.787
H-Index - 25
ISSN - 2055-5822
DOI - 10.1002/ehf2.12317
Subject(s) - medicine , perfusion , scintigraphy , heart failure , pulmonary wedge pressure , nuclear medicine , radiology , single photon emission computed tomography , perfusion scanning , pulmonary artery , gold standard (test) , cardiology
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.