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Published on: January 6, 2019
Early effects of kidney transplantation on the heart - A cardiac magnetic resonance multi-parametric study
Manvir K Hayer1, Ashwin Radhakrishnan1, Anna M Price1
1Birmingham Cardiorenal Group, Institute of Cardiovascular Sciences, University of Birmingham, United Kingdom of Great Britain and Northern Ireland.
Insights
Native myocardial T1 times are elevated in end-stage kidney disease (ESKD) and remain stable after kidney transplantation, suggesting they are a reliable marker for diffuse interstitial myocardial fibrosis (DIF) in chronic kidney disease (CKD).
Area of Science:
- Cardiovascular Imaging
- Nephrology
- Radiology
Background:
- Elevated native myocardial T1 times in chronic kidney disease (CKD) may indicate diffuse interstitial myocardial fibrosis (DIF) or edema/inflammation.
- Gadolinium-based contrast agents (GBCA) use is limited in end-stage kidney disease (ESKD) due to nephrogenic systemic fibrosis concerns, hindering extracellular volume (ECV) measurement.
- Kidney transplantation offers a unique window to assess myocardial changes as volume status normalizes.
Purpose of the Study:
- To evaluate the stability of myocardial T1 and T2 times before and after kidney transplantation.
- To compare pre- and post-transplant myocardial T1/T2 times with ECV measurements.
- To determine if native T1 times can reliably assess diffuse interstitial myocardial fibrosis (DIF) in CKD patients.
Main Methods:
- Serial cardiovascular magnetic resonance imaging (CMR) including T1 and T2 mapping was performed on 24 ESKD patients.
- ECV was measured using GBCA post-transplantation in patients with eGFR >30 ml/min/1.73 m².
- Eighteen age- and sex-matched healthy controls underwent single-timepoint CMR for comparison.
Main Results:
- ESKD patients exhibited higher ECV and T2 times compared to controls.
- Post-transplantation, septal T1 times increased, and left ventricular (LV) volumes decreased, while LV mass remained unchanged.
- Myocardial T2 times showed no significant change after transplantation.
Conclusions:
- Elevated ECV and myocardial T1 times in ESKD support DIF as the primary cause, though myocardial edema may contribute.
- The lack of change in T1 and T2 times post-transplantation indicates that native myocardial T1 times are a stable and reliable measure of DIF in CKD.
- This finding supports the use of native T1 mapping for assessing myocardial fibrosis in CKD patients, circumventing GBCA risks.
Abstract:
Increased native myocardial T1 times in chronic kidney disease (CKD) may be due to diffuse interstitial myocardial fibrosis (DIF) or due to interstitial edema/inflammation. Concerns relating to nephrogenic systemic fibrosis with gadolinium-based contrast agents (GBCA) limit their use in end-stage kidney disease (ESKD) to measure extracellular volume (ECV) and characterise myocardial fibrosis. This study aimed to examine stability of myocardial T1 and T2 times before, and within 2 months after kidney transplantation; a time frame when volume status normalises but myocardial remodelling is unlikely to have occurred, and to compare these with ECV using GBCA after transplantation. Twenty-four patients with ESKD underwent serial cardiovascular magnetic resonance imaging, including T1 and T2 mapping. GBCA was administered on follow-up provided eGFR was >30 ml/min/1.73 m2. Eighteen age- and sex-matched controls were studied at one timepoint. ECV (ECV 28 ± 2% vs. 24 ± 2%, p = 0.001) and T2 times were higher in ESKD compared to controls. After transplantation, septal T1 times increased (MOLLI 985 ms ± 25 vs. 1002 ms ± 30, p = 0.014; ShMOLLI 974 ms ± 39 vs. 992 ms ± 33, p = 0.113), LV volumes reduced (LVEDvol indexed 79 ± 24 vs. 63 ± 20 ml/m2, p = 0.005) but LV mass was unchanged (LV mass index 89 g/m2 ± 38 to 83 g/m2 ± 23, p = 0.141). T2 times did not change after transplantation. Both ECV and myocardial T1 times are elevated in ESKD, supporting the theory that elevated T1 times are due to DIF, although a contribution from myocardial edema cannot be fully excluded. The lack of any fall in T1 or T2 times after transplantation suggests that myocardial T1 times are a stable measure of DIF in CKD.
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