- Poster presentation
- Open Access
Multiparametric cardiovascular magnetic resonance surveillance of acute cardiac allograft rejection and characterisation of transplantation-associated myocardial injury
© Miller et al.; licensee BioMed Central Ltd. 2014
- Published: 16 January 2014
- Cardiovascular Magnetic Resonance
- Myocardial Blood Flow
- Circumferential Strain
- Primary Graft Dysfunction
- Absolute Myocardial Blood Flow
Acute cardiac allograft rejection (ACAR) affects approximately 20% of patients in the first year post-transplantation, represents a leading cause of death during this period and confers higher two- and four-year mortality in patients surviving beyond the first year. Clinical features of ACAR are unreliable, therefore serial surveillance endomyocardial biopsies are performed in order to detect ACAR at an early stage, however the biopsy process is associated with a number of limitations. This study aimed to prospectively and longitudinally evaluate the performance of multiparametric cardiovascular magnetic resonance (CMR) for detecting and monitoring ACAR in the early phase post-transplant, and characterize graft recovery following transplantation.
All patients receiving a heart transplant at a single UK centre over a 25 month period of were prospectively approached within one month of transplantation. Multiparametric CMR was prospectively performed on the same day as biopsy on four separate occasions (to coincide with biopsies scheduled at 6 weeks, 10 weeks, 15 weeks and 20 weeks post-transplant). CMR included assessment of global and regional ventricular function (LV volumetrics, mass, ejection fraction, circumferential strain and strain rate, torsion (circumferential-longitudinal shear)), myocardial tissue characterisation (T1 mapping, T2 mapping, extracellular volume, LGE) and pixel-wise absolute myocardial blood flow quantification. CMR parameters were compared with biopsy findings. As is standard, > grade 2R ACAR was considered significant.
This study provides novel insight into the myocardial injury associated with transplantation and primary graft dysfunction, and its recovery, however multiparametric CMR was not able to accurately detect ACAR during the early phase post-transplantation.
CAM is supported by a Fellowship from the National Institute for Health Research, UK (NIHR-DRF-2010-03-98). CAM has received project funding from the Mason Medical Research Foundation Charity. CAM, SGW, NY and MS have received research funding from New Start Transplant Charity, UK.
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.