Purpose: Cardiac allograft vasculopathy (CAV) is one of the major factors limiting long-term survival after heart transplantation. The use of annual coronary angiograms is an invasive procedure with inherent potential complications. Non-invasive testing such as dobutamine stress echocardiography has been demonstrated to have prognostic outcome after heart transplant. The use of regadenoson nuclear scans has been of increasing use in the recent past as another non-invasive means to detect CAV. It is not clear whether these nuclear scans are predictive of subsequent poor outcome.

Methods: Between 1994 and 2012 we assessed 225 of heart transplant patients who underwent a regadenoson scan. Patients were divided into those who had normal regadenoson scans and those with abnormal regadenoson scans. An abnormal regadenoson scan was defined as a scan with any fixed perfusion defects and/or reversible defects. Outcomes including 1-year subsequent survival, freedom from left ventricular (LV) dysfunction and freedom from percutaneous coronary intervention (PCI)/angioplasty were assessed.

Results: 1-year subsequent survival and freedom from LV dysfunction and PCI/angioplasty were significantly lower in patients with abnormal scans (see table). There was no difference between fixed defects versus any reversible defects for outcome.

Conclusion: Abnormal regadenoson scans are predictive of poor outcome after heart transplantation. Aggressive strategies such as more frequent angiograms or re-transplant for select patients should be considered.

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