Purpose Cardiac magnetic resonance (CMR) is a powerful tool for myocardial tissue characterization and provides relevant prognostic information in various cardiac pathologies. Aim of our study was the assessment of the prognostic value of CMR acquired at one year after heart transplant (HTX). Methods From 2010 to 2014, 54 consecutive patients (pts; mean age 45,7; 31 male), underwent CMR on a 1.5T scanner (Avanto, Siemens) 1 year after HTX. The pts didn't have contraindications to CMR, neither an acute illness or recent (< 3 months) rejection at the time of scheduled scan. CMR protocol included cine images, STIR T2-weighted images, pre- and post-contrast T1 mapping (modified MOLLI sequence), T2 mapping with a true-fisp sequence, and late enhancement (LE) after the administration of 0.15 mmol/kg of gadobutrol (Gadovist, Bayer). Images were analyzed off line with a dedicated software (CVi42, Circle Cardiovascular Imaging). Biventricular volumes and ejection fraction (EF), left ventricular mass, T1 and T2 relaxation times, extracellular volume (ECV), presence and quantity of LE and left ventricular longitudinal strain were calculated. Data were compared to those of a control group (CG) of 21 pts with normal CMR scan. CMR parameters were related to a composite end-point (cardiovascular death, heart failure, re-transplant, asymptomatic EF reduction > 10%, myocardial ischaemia, late cellular rejection, late antibody mediate rejection, arrythmias or sincope) during a median follow-up of 40 months. Results In HTX, pre-contrast T1 and T2 were longer, while post-contrast T1 was shorter than in the CG. LE was present in 24 pts (44%) with a median quantity of 4,9 g (4.38%). During follow-up 12 adverse events (22%) occurred. The regression Cox analysis identified as indipendent variables of cardiovascular outcome: left ventricular hypertrophy (LVH) (HR 4,309; 1,365-13,607 95% CI; P-value = 0,0128), pre-contrast T1 (HR 1,175 per 10 units increment; 1,045-1,32 95% CI; P-value = 0,0069) and ECV (HR 1,287 per each % unit increment; 1,365-13,607 95% CI; P-value = 0,0044). The presence of LVH (p=0.0066), of pre-contrast T1 > 1001 msec (p= 0.0007) and ECV > 29% (p=0.0009) were significantly related to adverse events at Kaplan-Meier curves analysis. Conclusion CMR may supply relevant prognostic information in HTX, helping in therapeutic decision-making and should become a routine exam in HTX
Prognostic Value of Cardiac Magnetic Resonance Acquired at One Year after Heart Transplantation
Rimoldi O;
2019
Abstract
Purpose Cardiac magnetic resonance (CMR) is a powerful tool for myocardial tissue characterization and provides relevant prognostic information in various cardiac pathologies. Aim of our study was the assessment of the prognostic value of CMR acquired at one year after heart transplant (HTX). Methods From 2010 to 2014, 54 consecutive patients (pts; mean age 45,7; 31 male), underwent CMR on a 1.5T scanner (Avanto, Siemens) 1 year after HTX. The pts didn't have contraindications to CMR, neither an acute illness or recent (< 3 months) rejection at the time of scheduled scan. CMR protocol included cine images, STIR T2-weighted images, pre- and post-contrast T1 mapping (modified MOLLI sequence), T2 mapping with a true-fisp sequence, and late enhancement (LE) after the administration of 0.15 mmol/kg of gadobutrol (Gadovist, Bayer). Images were analyzed off line with a dedicated software (CVi42, Circle Cardiovascular Imaging). Biventricular volumes and ejection fraction (EF), left ventricular mass, T1 and T2 relaxation times, extracellular volume (ECV), presence and quantity of LE and left ventricular longitudinal strain were calculated. Data were compared to those of a control group (CG) of 21 pts with normal CMR scan. CMR parameters were related to a composite end-point (cardiovascular death, heart failure, re-transplant, asymptomatic EF reduction > 10%, myocardial ischaemia, late cellular rejection, late antibody mediate rejection, arrythmias or sincope) during a median follow-up of 40 months. Results In HTX, pre-contrast T1 and T2 were longer, while post-contrast T1 was shorter than in the CG. LE was present in 24 pts (44%) with a median quantity of 4,9 g (4.38%). During follow-up 12 adverse events (22%) occurred. The regression Cox analysis identified as indipendent variables of cardiovascular outcome: left ventricular hypertrophy (LVH) (HR 4,309; 1,365-13,607 95% CI; P-value = 0,0128), pre-contrast T1 (HR 1,175 per 10 units increment; 1,045-1,32 95% CI; P-value = 0,0069) and ECV (HR 1,287 per each % unit increment; 1,365-13,607 95% CI; P-value = 0,0044). The presence of LVH (p=0.0066), of pre-contrast T1 > 1001 msec (p= 0.0007) and ECV > 29% (p=0.0009) were significantly related to adverse events at Kaplan-Meier curves analysis. Conclusion CMR may supply relevant prognostic information in HTX, helping in therapeutic decision-making and should become a routine exam in HTXI documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
