Value of Computed Tomography and Fluorodeoxyglucose-Positron Emission Tomography Imaging for Preoperative Screening in Advanced Heart Failure Therapies Candidates

Abstract

<h3>Purpose</h3> Careful selection of candidates for advanced heart failure therapies is paramount for the optimal allocation of resources. Since the value of computed tomography (CT) and fluorodeoxyglucose-positron emission tomography (FDG-PET) in this context remains unclear, imaging workup for these patients varies from one center to another. The objectives of this study are to assess the impact of CT and FDG-PET/CT in the evaluation of heart transplant (HTx) or ventricular assist devices (VAD) candidates and to assess the added value of FDG-PET/CT when performed following CT. <h3>Methods</h3> All the patients assessed for HTx or VAD in our institution between 2014 and 2021 were reviewed. Patients who underwent contrast-enhanced chest and abdominal CT and FDG-PET/CT within a 6 month-interval were included in the study. Imaging reports were reviewed for significant findings, defined as possible contraindications for HTx/VAD, having an impact on their medical or surgical management, or actionable findings. Medical records were also reviewed for subsequent diagnostic investigations and for the multidisciplinary team's final decision. <h3>Results</h3> In the 79 included patients, significant findings were found in 37 patients (46,8%) with CT and in 18 patients (22,8%) with FDG-PET/CT (p=.0015). Significant findings on CT were more frequently vascular-related than significant findings on FDG-PET/CT (39% vs 6%; p=.01), but significant findings of both modalities were equally suspicious of cancer (61% vs 42%; p=.19), infection (28% vs 11%; p=.11) and other findings (8% vs 17%; p=.32). Of the significant findings identified on FDG-PET/CT, 56% were not identified on CT. Finally, 4 patients had imaging findings precluding HTx/VAD; 2 cases were identified on both CT and FDG-PET/CT and 2 cases were identified on CT only (peripheral arterial disease). <h3>Conclusion</h3> The difference in proportions of imaging studies with significant findings between CT and FDG-PET/CT favored the use of CT. Thus, our study suggests that both CT and FDG-PET/CT may have a value in pre-assessment of candidates for advanced heart failure therapies. A progressive approach consisting of CT followed by FDG-PET/CT as needed may be a reasonable work-up strategy. Further studies are needed to confirm these findings.