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. 2010 Jan;12(1):45-51.
doi: 10.1093/eurjhf/hfp174.

Diagnostic performance of multisequential cardiac magnetic resonance imaging in acute cardiac allograft rejection

Andrew J Taylor  1 , Gautam Vaddadi, Heinz Pfluger, Michelle Butler, Peter Bergin, Angeline Leet, Meroula Richardson, Joshi Cherayath, Leah Iles, David M Kaye
Affiliations

Diagnostic performance of multisequential cardiac magnetic resonance imaging in acute cardiac allograft rejection

Andrew J Taylor et al. Eur J Heart Fail. 2010 Jan.

Abstract

Aims: We evaluated cardiac magnetic resonance imaging (CMR) as a non-invasive test for cardiac allograft rejection.

Methods and results: We performed CMR on 50 heart-transplant recipients. Acute rejection was confirmed in 11 cases by endomyocardial biopsy (EMB) and presumed in 8 cases with a recent fall in left-ventricular ejection fraction (LVEF) not attributable to coronary allograft vasculopathy. Control patients had both normal LVEF and no significant rejection on EMB. Cardiac magnetic resonance imaging evaluated myocardial function, oedema, and early and late post-Gadolinium-DTPA contrast enhancement. Patients with confirmed rejection demonstrated elevated early relative myocardial contrast enhancement (4.1 +/- 0.3 vs. 2.8 +/- 0.2, P < 0.001) and a trend to higher oedema suggested by higher relative myocardial intensity on T(2)-weighted imaging compared to controls (2.1 +/- 0.1 vs. 1.7 +/- 0.1, P = 0.1). With rejection defined as increased early contrast enhancement or myocardial oedema, the sensitivity and specificity of CMR compared with EMB were 100 and 73%, respectively. Eight patients with presumed rejection also had elevated early myocardial contrast enhancement compared with controls, (8.7 +/- 1.9 vs. 2.8 +/- 0.2, P < 0.05), which reduced following increased immunosuppression (8.7 +/- 1.9 vs. 4.6 +/- 1.2, P < 0.05). In these patients LVEF improved following increased immunosuppression (32 +/- 5 vs. 46 +/- 5%, P < 0.05).

Conclusion: Cardiac magnetic resonance imaging is a promising modality for non-invasive detection of cardiac allograft rejection.

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Figures

Figure 1
Figure 1
Cardiac magnetic resonance in confirmed rejection. Box and whisker plots of early relative myocardial contrast enhancement (Relative enhancement, A) and myocardial oedema (Relative short inversion time inversion recovery, B) in patients with Grade 0, 1R, and 2R rejection (*P < 0.05 compared with Grade 0 and 1R by ANOVA).
Figure 2
Figure 2
Diagnostic performance of cardiac magnetic resonance. Receiver operating characteristic analysis curves representing the diagnostic performance of early relative myocardial contrast enhancement (Relative enhancement, A) and myocardial oedema (Relative short inversion time inversion recovery, B) in the diagnosis of confirmed acute cellular rejection.
Figure 3
Figure 3
Late gadolinium-DTPA enhancement images in cardiac transplantation. There is a small area of late gadolinium enhancement in the region of the right and left-ventricular junction of a control patient (A, white arrow). A long-term post-transplant patient with a non-diagnostic endomyocardial biopsy but presumed rejection has a large amount of late gadolinium enhancement in the right-ventricular aspect of the interventricular septum (B, black arrows). The area of bright signal intensity adjacent to the left-ventricular wall clearly extends across the atrioventicular groove, and is likely to represent epicardial fat.
Figure 4
Figure 4
Cardiac magnetic resonance in presumed rejection. Box and whisker plots of early relative myocardial contrast enhancement (Relative enhancement, A) and myocardial oedema (Relative short inversion time inversion recovery, B) in patients with presumed rejection compared with controls (*P < 0.05).
See this image and copyright information in PMC

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