Thoracic transplantationUtility of cardiac magnetic resonance imaging for the diagnosis of heart transplant rejection
Section snippets
Patients
Fifty heart transplant patients admitted to the cardiology department for performance of a scheduled endomyocardial biopsy were prospectively and consecutively enrolled in this study. Ten patients who did not give voluntary consent were excluded. Sixty-four examinations were performed in the remaining 40 patients.
Cardiac MRI
High-field 1.5 T GE CV/i scanner.
T1 (breathhold fast spin-echo T1-weighted images), T2 and STIR (proton density) anatomic sequences, pre- and 2 minutes postcontrast.
Cine sequences
Results
Mean age: 51 ± 13 years. Women 5, men 35. Time since HT: 13 to 3725 days. No significant differences were found between rejection and ventricular function and volumes or presence of effusion and hypertrophy. Visual estimation of cardiac perfusion and viability sequences did not detect significant changes in these patients. A clear trend towards higher values in the different measures of uptake was noted in the patients with necrosis, which was statistically significant for relative myocardial
Discussion
This is the first study to use cardiac MRI in heart transplant recipients under real clinical conditions. All our patients were receiving immunosuppresive medication and three of them even required intravenous steroid administration, but our results were not controlled for the amount of medication required. Experimental studies have shown that the change in T1 and T2 relaxation times in these patients versus controls is statistically significant in the absence of immunosuppression, but
Conclusions
- (1)
Cardiac MRI is a promising technique for diagnosis of rejection.
- (2)
Patients with myocyte necrosis show a clear trend toward increased myocardial uptake.
- (3)
Interstitial fibrosis is associated with decreased levels of uptake.
References (10)
Eur J Radiol
(2001)Clin Radiol
(2000)Circulation
(1998)- et al.
Circulation
(1999) Invest Radiol
(1995)
Cited by (36)
Role of Radiology in Assessment of Postoperative Complications of Heart Transplantation
2024, Radiologic Clinics of North AmericaCardiovascular Magnetic Resonance Imaging in the Evaluation of Cardiac Transplantation
2018, Cardiovascular Magnetic Resonance: A Companion to Braunwald’s Heart DiseaseDecision making about healthcare-related tests and diagnostic test strategies. Paper 2: a review of methodological and practical challenges
2017, Journal of Clinical EpidemiologyCitation Excerpt :We developed the following definition that encompasses the intended use by various authors: a new test is a test that has not previously been used in the intended role or for the intended purpose. Interest in this “new test” may exist because it is perceived to be faster in determining test results, require less expertise [17], be less invasive [18], improve accuracy or efficacy [19], require less resources, or be more feasible for various reasons [20]. Table 2 summarizes the roles of tests and their definitions.
Multimodality Noninvasive Imaging in the Monitoring of Pediatric Heart Transplantation
2017, Journal of the American Society of EchocardiographyCitation Excerpt :In summary, CMR has been studied as a potential means for noninvasive detection of rejection because it can identify areas of hyperemia, inflammation, and areas of scar and fibrosis using LGE. Single-center studies have reported using LGE patterns to identify areas of active inflammation, and others have examined signal intensity patterns in the early postcontrast phase to identify inflammation and necrosis.11,57,67 Large prospective studies are needed to better understand the true sensitivity and specificity of these techniques.
Correlation of cardiovascular magnetic resonance imaging findings and endomyocardial biopsy results in patients undergoing screening for heart transplant rejection
2015, Journal of Heart and Lung TransplantationCitation Excerpt :Skowronski et al41 showed that acute rejection was associated with increased RV stiffness and pressure, but in their small series, serial measurements of RV volume showed a reduction in RV volume during rejection compared with the baseline. Almenar et al30 did not detect a difference in RV ejection fraction or size between those with and without rejection. In our study, RV volume significantly predicted acute allograft rejection on multivariate analysis.
The Role of Multimodality Cardiac Imaging in the Transplanted Heart
2009, JACC: Cardiovascular ImagingCitation Excerpt :Several noninvasive imaging techniques (clinically accepted and investigational) have been performed to detect ACR at different stages in the disease process (Fig. 1). With current advances in immunosuppression, the majority of patients who develop ACR have no significant changes in left ventricular (LV) ejection fraction regardless of the imaging modality used (2–4). However, monitoring cardiac allograft systolic function is important in suspected or proven ACR because more aggressive immunosuppression can lead to improvement in LV function in patients with depressed function.