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

ESC Heart Fail. 2018 Oct;5(5):902-910. doi: 10.1002/ehf2.12317. Epub 2018 Jul 17.


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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Cardiac Catheterization / methods*
  • Female
  • Follow-Up Studies
  • Heart Failure / diagnosis*
  • Heart Failure / physiopathology
  • Heart Ventricles / diagnostic imaging*
  • Heart Ventricles / physiopathology
  • Humans
  • Lung / diagnostic imaging*
  • Lung / physiopathology
  • Male
  • Middle Aged
  • Perfusion Imaging / methods*
  • Prospective Studies
  • Reproducibility of Results
  • Severity of Illness Index
  • Time Factors
  • Tomography, Emission-Computed, Single-Photon / methods*
  • Ventilation-Perfusion Ratio
  • Ventricular Function, Right / physiology*