Clinical Scorecard: Evaluating the Use of Perfusion-Only Q-SPECT as a Diagnostic Tool for CTEPH in Low-Resource Environments: A Study on Minimizing Unnecessary Referrals to Specialized Centers

At a Glance

Key Highlights

• CTEPH is a rare but potentially curable cause of pulmonary hypertension.
• Perfusion-only Q-SPECT can serve as a practical alternative in low-resource settings.
• High negative predictive value (NPV) of Q-SPECT makes it a reliable rule-out tool for CTEPH.
• Only 7–29% of CTEPH cases are accurately diagnosed, often at advanced stages.
• Diagnostic delays in CTEPH are associated with poorer prognosis.
• Timely diagnosis is crucial for improving patient outcomes.

Guideline-Based Recommendations

Diagnosis

• Use transthoracic echocardiography (TTE) and V/Q scintigraphy as first-line investigations.
• Confirm diagnosis with computed tomography pulmonary angiography (CTPA) and right heart catheterization (RHC) if indicated, as RHC is essential for definitive diagnosis.

Management

Monitoring & Follow-up

Risks

Patient & Prescribing Data

Patients with significant perfusion defects may require further evaluation and potential referral to specialized centers. Consider contraindications for Q-SPECT.

Clinical Best Practices

• Utilize perfusion-only Q-SPECT in centers lacking advanced imaging capabilities.
• Ensure proper patient selection based on PASP and clinical symptoms.
• Implement a standardized protocol for image acquisition and interpretation.
• Establish follow-up protocols after Q-SPECT to ensure comprehensive care.

References

• ESC Guidelines 2019
• Study on diagnostic delays in CTEPH