Related Experiment Video
Updated: Jul 17, 2026
Cardiac Loading using Passive Left Atrial Pressurization and Passive Afterload for Graft Assessment
Published on: August 2, 2024
A comparison of myocardial perfusion and rejection in cardiac transplant patients
Andrew L Rivard1, Cory M Swingen, Donnevan Blake
1Department of Surgery, Experimental Surgical Services, University of Minnesota, MMC 220, 420 Delaware Street SE, Minneapolis, MN 55455, USA. rivar011@umn.edu
Introduction:
Although histological evaluation of the cardiac tissue is the current gold standard for evaluation of rejection, we hypothesized that cardiac perfusion MRI is a safe non-invasive method that correlates tissue blood flow changes with biopsy proven rejection in the cardiac transplant patient.
Materials And Methods:
In a retrospective study from 1984-2001, 83 patients underwent 135 MR Gd-DTPA imaging studies. In 8 patients (9%), biopsies graded 2 or higher (by ISHLT criteria) provided evidence of rejection. Patients were age and sex matched to 11 non-rejected controls for imaging analysis. Time-signal intensity curves generated for a mid-ventricle LV short axis slice during rest and adenosine stress allowed determination of myocardial blood flow (MBF, ml/min/gm). ROC curve analysis by SPSS allowed estimation of sensitivity and specificity.
Results:
At rest, there was no difference in MBF between patients with prior rejection vs. those without (1.18 +/- 0.26 vs. 1.16 +/- 0.29). At stress there was a decrease in MBF for patients with prior rejection episodes (3.27 +/- 0.74) compared to no rejection (3.60 +/- 0.72), P = 0.067). The area under the ROC curve was 0.82, with specificity and sensitivity of 75% and 81%, respectively.
Conclusion:
This study suggests that perfusion MR imaging can be used in assessing the cardiac transplant patient for rejection related microvascular changes. The high specificity and sensitivity recorded from the ROC curve illustrates the potential utility of this diagnostic test for future studies.
Insights
Cardiac perfusion MRI shows promise in detecting heart transplant rejection by assessing changes in myocardial blood flow (MBF). This non-invasive technique offers high sensitivity and specificity for identifying rejection-related microvascular changes.
Area of Science:
- Cardiovascular Imaging
- Transplant Medicine
- Radiology
Background:
- Histological evaluation is the gold standard for cardiac transplant rejection.
- Non-invasive methods are needed to complement biopsy-proven rejection assessment.
- Cardiac perfusion MRI (magnetic resonance imaging) was investigated as a potential non-invasive tool.
Purpose of the Study:
- To evaluate cardiac perfusion MRI's ability to detect microvascular changes associated with rejection in heart transplant patients.
- To determine if myocardial blood flow (MBF) changes measured by MRI correlate with biopsy-proven rejection.
Main Methods:
- Retrospective analysis of 83 heart transplant patients (1984-2001) with 135 MRI studies.
- Myocardial blood flow (MBF) was measured at rest and during adenosine stress using time-signal intensity curves.
- Patients with biopsy-proven rejection (grade ≥2) were compared to age- and sex-matched controls.
Main Results:
- No significant difference in resting MBF between rejected and non-rejected patients.
- A trend towards decreased MBF during stress in patients with prior rejection episodes (P=0.067).
- Receiver Operating Characteristic (ROC) curve analysis yielded an area of 0.82, with 81% sensitivity and 75% specificity.
Conclusions:
- Perfusion MRI shows potential for assessing cardiac transplant rejection by detecting microvascular changes.
- The high sensitivity and specificity suggest utility for this diagnostic test in future studies.
- Cardiac perfusion MRI offers a safe, non-invasive method to evaluate transplant recipients.
