Cardiac magnetic resonance imaging in detection of progressive graft dysfunction in pediatric heart transplantation
Kae Watanabe1, Nicoleta C Arva2, Joshua D Robinson3,4,5
1Lille Frank Abercrombie Section of Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA.
Insights
Cardiac magnetic resonance imaging (CMR) shows potential for screening chronic graft failure (CGF) in pediatric heart transplant (PHT) patients. Abnormalities on CMR correlate with fibrosis and microvessel disease (MVD) found in biopsies, aiding CGF surveillance.
Area of Science:
- Cardiology
- Transplant Medicine
- Medical Imaging
Background:
- Chronic graft failure (CGF) in pediatric heart transplant (PHT) is a significant clinical challenge.
- CGF often presents with fibrosis and microvessel disease (MVD), detectable via endomyocardial biopsy (EMB).
- Optimal surveillance methods for CGF are currently lacking.
Purpose of the Study:
- To evaluate the utility of cardiac magnetic resonance imaging (CMR) as a surveillance tool for CGF in PHT.
- To assess associations between CMR findings and historical/EMB correlates of CGF.
Main Methods:
- Retrospective analysis of PHT patients who underwent comprehensive CMR between September 2015 and January 2022.
- EMB within 6 months was graded for fibrosis and MVD.
- Correlation analysis and logistic regression were used to evaluate associations.
Main Results:
- Forty-seven PHT patients were studied; 22% had cardiac allograft vasculopathy (CAV) and 34.2% had historical rejection.
- CAV and historical rejection were associated with higher global T2 and peak T2 on CMR.
- Higher fibrosis scores correlated with smaller indexed left ventricular mass, and MVD correlated with lower indexed left ventricular end-diastolic volume.
Conclusions:
- Adverse ventricular remodeling and abnormal myocardial characteristics on CMR are observed in PHT patients with CAV, historical rejection, fibrosis, and MVD.
- CMR demonstrates potential as a non-invasive screening tool for CGF in pediatric heart transplant recipients.
Background:
Chronic graft failure (CGF) in pediatric heart transplant (PHT) is multifactorial and may present with findings of fibrosis and microvessel disease (MVD) on endomyocardial biopsy (EMB). There is no optimal CGF surveillance method. We evaluated associations between cardiac magnetic resonance imaging (CMR) and historical/EMB correlates of CGF to assess CMR's utility as a surveillance method.
Methods:
Retrospective analysis of PHT undergoing comprehensive CMR between September 2015 and January 2022 was performed. EMB within 6 months was graded for fibrosis (scale 0-5) and MVD (number of capillaries with stenotic wall thickening per field of view). Correlation analysis and logistic regression were performed.
Results:
Forty-seven PHT with median age at CMR of 15.7 years (11.6, 19.3) and time from transplant of 6.4 years (4.1, 11.0) were studied. Cardiac allograft vasculopathy (CAV) was present in 11/44 (22.0%) and historical rejection in 14/41 (34.2%). CAV was associated with higher global T2 (49.0 vs. 47.0 ms; p = 0.038) and peak T2 (57.0 vs. 53.0 ms; p = 0.013) on CMR. Historical rejection was associated with higher global T2 (49.0 vs. 47.0 ms; p = 0.007) and peak T2 (57.0 vs. 53.0 ms; p = 0.03) as well as global extracellular volume (31.0 vs. 26.3%; p = 0.03). Higher fibrosis score on EMB correlated with smaller indexed left ventricular mass (rho = -0.34; p = 0.019) and greater degree of MVD with lower indexed left ventricular end-diastolic volume (rho = -0.35; p = 0.017).
Conclusion:
Adverse ventricular remodeling and abnormal myocardial characteristics on CMR are present in PHT with CAV, historical rejection, as well as greater fibrosis and MVD on EMB. CMR has the potential use for screening of CGF.
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