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Late enhancement in 39 cardiac transplant patients: prevalence, pattern, and extent
© Butler et al; licensee BioMed Central Ltd. 2009
- Published: 28 January 2009
- Cardiovascular Magnetic Resonance
- Myocardial Segment
- Delay Enhancement
- Inversion Recovery Sequence
- Phase Sensitive Inversion Recovery
To better characterize delayed enhancement patterns in the cardiac transplant population.
Cardiac transplant patients experience significant morbidity related to transplant vasculopathy and acute transplant rejection, both of which can cause scarring of the myocardium. Contrast enhanced cardiovascular magnetic resonance (CMR) has the unique ability to visualize and quantify myocardial scarring. It is well understood that myocardial infarctions resulting from transplant vasculopathy adversely affect prognosis and modify therapy. There is a growing body of evidence from non-transplant disease states, that the presence of non-infarct myocardial scar is also correlated to poor prognosis. Currently there is very little data on the scarring patterns present in the cardiac transplant population and it is our goal to better describe this pathology.
Thirty-nine transplant patients underwent contrast enhancement imaging at the time of routine myocardial biopsy at two hospital centers in Alberta, Canada. Standard phase sensitive inversion recovery sequences were used on commercially available scanners (Siemens Avanto and Sonata, Siemens, Erlangen, Germany). Delayed enhancement (DE) was evaluated visually using CMR42 (Circle Canada Inc, Calgary, Canada) software analysis package by two independent readers. DE had to be cross-referenced in two orthogonal views. Disagreements were settled by consensus. The extent of DE was assessed semi-quantitatively by scoring each of the 17 myocardial segments according to the proportion of DE in each segment (1 = 75%). The scores of the 17 individual myocardial segments were added together to give an aggregate DE burden.
DE is a common feature in the transplant population. Most DE observed is in a non-ischemic pattern; however a significant proportion had DE patterns consistent with infarction. The relationship between DE and cumulative episodes of rejection, hospitalization, and long term prognosis needs to be explored in more detail.
This article is published under license to BioMed Central Ltd.