- Oral presentation
- Open Access
Multiparametric cardiovascular magnetic resonance assessment of cardiac allograft vasculopathy
- Christopher A Miller1, 2,
- Jaydeep Sarma1,
- Josephine H Naish2,
- Nizar Yonan1, 3,
- Simon G Williams1, 3,
- Steven M Shaw1, 3,
- David Clark4,
- Keith Pearce1,
- Martin Stout1,
- Rahul Potluri1,
- Alex Borg1,
- Glyn Coutts5,
- Saqib Chowdhary1, 3,
- Gerry P McCann6,
- Geoffrey J Parker2,
- Simon G Ray1, 3 and
- Matthias Schmitt1, 2
https://doi.org/10.1186/1532-429X-16-S1-O3
© Miller et al.; licensee BioMed Central Ltd. 2014
- Published: 16 January 2014
Keywords
- Cardiovascular Magnetic Resonance
- Late Gadolinium Enhancement
- Invasive Coronary Angiography
- Cardiac Allograft Vasculopathy
- Myocardial Perfusion Reserve
Background
Cardiac allograft vasculopathy (CAV) continues to limit the long-term survival of heart transplant recipients. CAV affects both the epicardial arteries and the microvessels, however it does so independently, and epicardial and microvascular disease are both independently predictive of prognosis. Despite being associated with considerable limitations, coronary angiography has a class I recommendation for CAV surveillance and annual or biannual surveillance angiography is performed routinely in most centers. The aim of this study was to evaluate the diagnostic performance of multiparametric CMR in CAV, and to compare the performance of CMR to that of invasive coronary angiography, using contemporary invasive epicardial artery and microvascular assessment techniques as reference standards.
Methods
All transplant recipients referred for surveillance angiography at a single UK transplant center over a 2-year period were prospectively screened for study eligibility. Patients prospectively underwent coronary angiography followed by coronary intravascular ultrasound (IVUS; epicardial artery reference standard) and index of microcirculatory resistance (IMR; microvascular reference standard). Within one month patients underwent multiparametric CMR. CMR assessment included LV volumetrics, circumferential strain and strain rate, torsion (circumferential-longitudinal shear), pixel-wise absolute myocardial blood flow quantification using generalized Tikhonov deconvolution with a b-spline representation of the impulse response function, late gadolinium enhancement and T1 mapping/extracellular volume measurement. Angiographic and CMR data were compared with the invasive epicardial artery (IVUS intima-media ("plaque") volume index) and microvascular (IMR) reference standards. In addition, 10 age- and sex-matched healthy volunteers underwent CMR.
Results
Associations between patient characteristics, angiography data and CMR data with invasive reference standards of epicardial artery disease (IVUS plaque volumes index; 1) and microvascular disease (IMR; 2).
1. Associations with coronary intravascular ultrasound (IVUS) plaque volume index | |||
---|---|---|---|
Univariable associations | A. Patient characteristics | β | p value |
Time since transplantation | 0.49 | 0.001 | |
Donor age | 0.29 | 0.058 | |
B. Angiography data | |||
Maximum angiographic stenosis | 0.33 | 0.024 | |
C. CMR data | |||
Early diastolic SR | -0.38 | 0.014 | |
MPR | -0.55 | < 0.001 | |
Infarct LGE | 0.35 | 0.022 | |
Multivariable stepwise regression | A. Including patient characteristics and angiographic data | ||
Time since transplantation | 0.49 | 0.001 | |
B. Including patient characteristics and CMR data | |||
Time since transplantation | 0.47 | < 0.001 | |
Early diastolic SR | -0.24 | 0.049 | |
MPR | -0.57 | < 0.001 | |
2. Associations with index of microcirculatory resistance (IMR) | |||
Univariable associations | A. Patient characteristics | ||
Donor age | 0.39 | 0.007 | |
Donor hypertension | 0.35 | 0.016 | |
B. Angiography data | |||
Maximum angiographic stenosis | -0.16 | 0.281 | |
C. CMR data | |||
LVEF | -0.36 | 0.015 | |
εcc | 0.46 | 0.002 | |
MPR | -0.55 | < 0.001 | |
Multivariable stepwise regression | Donor hypertension | 0.29 | 0.012 |
EF | -0.26 | 0.024 | |
MPR | -0.60 | < 0.001 |
Diagnostic performance of cardiovascular magnetic resonance myocardial perfusion reserve and angiography for detecting cardiac allograft vasculopathy (CAV). Diagnostic performance of cardiovascular magnetic resonance myocardial perfusion reserve (CMR) and angiography (angio) for detecting; (A) moderate cardiac allograft vasculopathy, defined as > median epicardial or microvascular disease; and (B) severe cardiac allograft vasculopathy, defined as > 75th centile epicardial or microvascular disease.
Conclusions
CAV, including epicardial and microvascular components, can be detected more accurately using non-invasive CMR-based absolute myocardial blood flow assessment than with invasive coronary angiography, the current clinical surveillance technique.
Funding
CAM is supported by a Fellowship from the National Institute for Health Research, UK (NIHR-DRF-2010-03-98). CAM, SGW, NY and MS have received research funding from New Start Transplant Charity, UK.
Authors’ Affiliations
Copyright
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.