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Multiparametric Cardiac Magnetic Resonance Imaging Detects Altered Myocardial Tissue and Function in Heart
Muhannad A Abbasi1, Allison M Blake2, Roberto Sarnari2
1Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. muhannadaboudabbasi@gmail.com.
Insights
Cardiac magnetic resonance (CMR) detects early functional and structural changes in heart transplant recipients with cardiac allograft vasculopathy (CAV). CMR tissue parameters differentiate mild from moderate/severe CAV, suggesting its diagnostic potential.
Area of Science:
- Cardiology
- Transplantation Medicine
- Medical Imaging
Background:
- Cardiac allograft vasculopathy (CAV) is a significant complication after heart transplantation (HTx).
- Early detection of CAV is crucial for patient outcomes.
- Assessing subclinical changes in HTx recipients is challenging.
Purpose of the Study:
- To evaluate the utility of cardiac magnetic resonance (CMR) in detecting functional and structural alterations in HTx recipients.
- To assess CMR's ability to identify changes associated with varying grades of CAV.
- To compare myocardial tissue characteristics between HTx recipients and healthy controls.
Main Methods:
- Seventy-seven HTx recipients and 18 controls underwent CMR, including cine imaging and T1/T2-mapping.
- Ventricular function and myocardial tissue parameters (T1, T2, extracellular volume) were quantified using a 16-segment model.
- CAV grading (0-3) was determined by coronary angiography according to International Society for Heart and Lung Transplantation criteria.
Main Results:
- The majority of HTx recipients (73%) had CAV (grade 1-3).
- Elevated global and segmental T2 values were observed in CAV-0 (no macrovasculopathy) compared to controls.
- HTx recipients with moderate/severe CAV (CAV-2/3) showed increased T2 values and decreased left ventricular ejection fraction compared to those with mild CAV (CAV-1).
Conclusions:
- Transplanted hearts exhibit functional and structural changes even without overt CAV (CAV-0).
- CMR tissue parameters effectively distinguish between mild (CAV-1) and moderate/severe (CAV-2/3) CAV.
- Further research is needed to establish CMR's definitive diagnostic role in CAV detection and classification.
Background:
Cardiac allograft vasculopathy (CAV) is a complication beyond the first-year post-heart transplantation (HTx). We aimed to test the utility of cardiac magnetic resonance (CMR) to detect functional/structural changes in HTx recipients with CAV.
Methods:
Seventy-seven prospectively recruited HTx recipients beyond the first-year post-HTx and 18 healthy controls underwent CMR, including cine imaging of ventricular function and T1- and T2-mapping to assess myocardial tissue changes. Data analysis included quantification of global cardiac function and regional T2, T1 and extracellular volume based on the 16-segment model. International Society for Heart and Lung Transplantation criteria was used to adjudicate CAV grade (0-3) based on coronary angiography.
Results:
The majority of HTx recipients (73%) presented with CAV (1: n = 42, 2/3: n = 14, 0: n = 21). Global and segmental T2 (49.5 ± 3.4 ms vs 50.6 ± 3.4 ms, p < 0.001;16/16 segments) were significantly elevated in CAV-0 compared to controls. When comparing CAV-2/3 to CAV-1, global and segmental T2 were significantly increased (53.6 ± 3.2 ms vs. 50.6 ± 2.9 ms, p < 0.001; 16/16 segments) and left ventricular ejection fraction was significantly decreased (54 ± 9% vs. 59 ± 9%, p < 0.05). No global, structural, or functional differences were seen between CAV-0 and CAV-1.
Conclusions:
Transplanted hearts display functional and structural alteration compared to native hearts, even in those without evidence of macrovasculopathy (CAV-0). In addition, CMR tissue parameters were sensitive to changes in CAV-1 vs. 2/3 (mild vs. moderate/severe). Further studies are warranted to evaluate the diagnostic value of CMR for the detection and classification of CAV.
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