The change of cerebral blood flow after heart transplantation in congestive heart failure: a voxel-based and automatic VOl analysis of Tc-99m ECD SPECT

To investigate the change of global and regional cerebral blood flow after heart transplantation (HT) in congestive heart failure (CHF) patients. Twenty-one patients with CHF who underwent HT (45±12 yrs, M/F=19/2) and 10 healthy volunteers (39±13 yrs, M/F = 7/3) were prospectively included. All patients underwent echocardiography and radionuclide angiography including brain and aorta with brain SPECT which was performed after iv bolus injection of Tc-99m ECD (740MBq) before (175±253 days) and after (129±82 days) HT. Patients were divided into two groups according to the interval between HT and postoperative SPECT [early follow-up (f/u): <6 mo, n=14; late f/u: >6 mo, n=7]. Global CBF (gCBF) of bilateral hemispheres were calculated by Patlak graphical analysis. Absolute rCBF map was obtained from brain SPECT by Lassen's correction algorithm. Age-corrected voxel-based analysis using SPM2 and automatic VOl analysis were performed to assess the rCBF change. Cardiac ejection fraction of all patients improved after HT (20.8%→64.0%). gCBF was reduced compared to normal before HT (35.7±3.9 vs. 49.1±3.0 ml/100g/min; p<0.001) and improved postoperatively (46.6±5.4, p<0.001). The preoperative gCBFs of early and late f/u group were not different (34.6±3.2 vs. 38.0±4.4, p=0.149) but postoperative gCBF (43.9±3.7) of late f/u group was higher than those (52.0±4.0) of early f/u group (p<0.001). On voxel-based analysis, preoperative rCBF was reduced in entire brain but most severely in bilateral superior and inferior frontal cortex, supplementary motor area, precuneus and anterior cingulum, compared to normals (uncorrected p<0.001). After HT, rCBF of these areas improved more significantly in late f/u group than in early f/u group but still lower than normals. Global CBF was significantly reduced in CHF patients and improved after HT. rCBFs of the frontal cortex, precuneus and cingulum were most severely reduced and slowly improved after HT compared to other brain regions