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Updated: Jun 18, 2026
In Vivo Quantitative Assessment of Myocardial Structure, Function, Perfusion and Viability Using Cardiac Micro-computed Tomography
Published on: February 16, 2016
Quantitative cardiovascular magnetic resonance myocardial perfusion can discriminate significant cardiac allograft
R Jablonowski1, H B Andersson2, C Fogarasi3
1Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skane University Hospital, Lund, Sweden.
Insights
Quantitative cardiovascular magnetic resonance (CMR) myocardial perfusion reserve (MPR) can detect cardiac allograft vasculopathy (CAV) stages. An MPR cutoff of 2.2 effectively identifies significant CAV (CAV2-3) with high sensitivity.
Area of Science:
- Cardiology
- Medical Imaging
- Transplantation Science
Background:
- Cardiac allograft vasculopathy (CAV) is a major cause of heart transplant complications.
- Early detection of CAV is crucial for patient outcomes.
Purpose of the Study:
- To evaluate quantitative cardiovascular magnetic resonance (CMR) myocardial perfusion for CAV detection.
- To establish a myocardial perfusion reserve (MPR) cutoff for significant CAV.
Main Methods:
- Retrospective analysis of 110 heart transplant patients with clinical CMR and angiography.
- Quantitative myocardial perfusion imaging at rest and stress using gadolinium contrast.
- MPR calculated as the ratio of stress to rest myocardial perfusion.
Main Results:
- A decrease in stress myocardial perfusion and MPR was observed with increasing CAV grade.
- MPR discriminated CAV2-3 with an ROC AUC of 0.88.
- An MPR cutoff of 2.2 demonstrated 100% sensitivity and 100% negative predictive value for CAV2-3.
Conclusions:
- Quantitative CMR-assessed MPR can effectively discriminate significant CAV (CAV2-3).
- An MPR cutoff of 2.2 is proposed for identifying CAV2-3 with high sensitivity and negative predictive value.
Aims:
Cardiac allograft vasculopathy (CAV) is a significant complication that contributes to both morbidity and mortality after heart transplantation. The aim of this study was to (i) assess if quantitative cardiovascular magnetic resonance (CMR) myocardial perfusion could detect different stages of CAV and (ii) establish a myocardial perfusion reserve (MPR) cut-off for significant CAV.
Methods And Results:
Patients with a heart transplant who had performed a clinical CMR scan and invasive angiography at two centres in Sweden were included in the study (n = 110). Quantitative short-axis perfusion maps were acquired using single-bolus gadolinium contrast, dual-sequence perfusion imaging at rest and during stress. Global myocardial perfusion (MP) was averaged across all segments at rest and stress and MPR was defined as the ratio between stress and rest MP. All invasive angiographies were reported according to the International Heart and Lung Transplantation CAV classification. Patients were classified as follows: 53% (58/110) as CAV0, 38% (42/110) as CAV1, and 9% (10/110) as CAV2-3. There was a gradual decrease of stress MP and MPR with increased CAV grade. The MPR could discriminate CAV2-3 with an area under the curve-receiver operating characteristic of 0.88, 95% confidence interval 0.78-0.98, and using a cut-off of 2.2, the sensitivity was 100%, specificity was 68%, and positive and negative predictive values were 21 and 100%.
Conclusion:
In this multi-centre retrospective study, MPR assessed by CMR could discriminate CAV2-3 with both high sensitivity and negative predictive value and a cut-off of MPR 2.2 is suggested.
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