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Diffuse Subepicardial Late Gadolinium Enhancement After Heart Transplant: A Potentially Ominous Finding

Aws Almufleh1, Habibat Garuba2, Lisa M Mielniczuk2

  • 1Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Cardiac Sciences Department, King Saud University, Riyadh, Saudi Arabia.

The Canadian Journal of Cardiology
|December 12, 2018
PubMed

Insights

Diffuse subepicardial late gadolinium enhancement (LGE) on cardiac MRI may indicate antibody-mediated rejection in heart transplant recipients. This pattern suggests poor outcomes and aids in risk stratification for allograft failure.

Area of Science:

  • Cardiovascular Imaging
  • Transplant Immunology

Background:

  • Late gadolinium enhancement (LGE) on cardiac MRI is prognostic in cardiac disease, including heart transplant (HT) recipients.
  • The specific causes and outcomes associated with LGE patterns post-HT are not well understood.

Observation:

  • Two highly allosensitized HT recipients with allograft failure exhibited identical diffuse subepicardial LGE patterns.
  • Antibody-mediated rejection and cardiac allograft vasculopathy are primary causes of mortality in HT recipients and are difficult to evaluate.

Findings:

  • A specific diffuse subepicardial LGE pattern was observed in two heart transplant recipients who experienced allograft failure.
  • This LGE pattern is hypothesized to be associated with antibody-mediated rejection and cardiac allograft vasculopathy.

Implications:

  • Cardiac MRI may play a role in evaluating antibody-mediated rejection in heart transplant recipients.
  • This LGE pattern could serve as a marker for poor prognosis and aid in risk stratification for allograft failure.

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