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. 2018 Aug 27;20(1):59.
doi: 10.1186/s12968-018-0480-9.

Cardiovascular magnetic resonance in heart transplant patients: diagnostic value of quantitative tissue markers: T2 mapping and extracellular volume fraction, for acute rejection diagnosis

Emmanuelle Vermes  1   2 , Clémence Pantaléon  3 , Adrien Auvet  3 , Nicolas Cazeneuve  4 , Marie Christine Machet  5 , Anne Delhommais  4 , Thierry Bourguignon  3 , Michel Aupart  3 , Laurent Brunereau  4
Affiliations

Cardiovascular magnetic resonance in heart transplant patients: diagnostic value of quantitative tissue markers: T2 mapping and extracellular volume fraction, for acute rejection diagnosis

Emmanuelle Vermes et al. J Cardiovasc Magn Reson. .

Abstract

Background: The diagnosis of acute rejection in cardiac transplant recipients requires invasive technique with endomyocardial biopsy (EMB) which has risks and limitations. Cardiovascular magnetic resonance imaging (CMR) with T2 and T1 mapping is a promising technique for characterizing myocardial tissue. The purpose of the study was to evaluate T2, T1 and extracellular volume fraction (ECV) quantification as novel tissue markers to diagnose acute rejection.

Methods: CMR was prospectively performed in 20 heart transplant patients providing 31 comparisons EMB-CMR. CMR was performed close to EMB. Images were acquired on a 1.5 Tesla scanner including T2 mapping (T2 prepared balanced steady state free precession) and T1 mapping (modified Look-Locker inversion recovery sequences: MOLLI) at basal, mid and apical level in short axis view. Global and segmental T2 and T1 values were measured before and 15 min (for T1 mapping) after contrast administration.

Results: Acute rejection was diagnosed in seven patients: six cellular rejections (4 grade IR, 2 grade 2R) and one antibody mediated rejection. Patients with acute rejection had significantly higher global T2 values at 3 levels: 58.5 ms [55.0-60.3] vs 51.3 ms [49.5-55.2] (p = 0.007) at basal; 55.7 ms [54.0-59.7] vs 51.8 ms [50.1-53.6] (p = 0.002) at median and 58.2 ms [54.0-63.7] vs 53.6 ms [50.8-57.4] (p = 0.026) at apical level. The area under the curve (AUC) for each level was 0.83, 0.79 and 0.78 respectively. Patients with acute rejection had significantly higher ECV at basal level: 34.2% [32.8-37.4] vs 27.4% [24.6-30.6] (p = 0.006). The AUC for basal level was 0.84. The sensitivity, specificity and diagnosis accuracy for basal T2 (cut off: 57.7 ms) were 71, 96 and 90% respectively; and for basal ECV: (cut off 32%) were 86, 85 and 85% respectively. Combining basal T2 and basal ECV allowed diagnosing all acute rejection and avoiding 63% of EMB.

Conclusions: In heart transplant patients, a combined CMR approach using T2 mapping and ECV quantification provides a high diagnostic accuracy for acute rejection diagnosis and could potentially decrease the number of routine EMB.

Keywords: Acute cardiac rejection; Cardiovascular magnetic resonance; Endomyocardial biopsy; T1 and T2 mapping.

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Conflict of interest statement

Ethics approval and consent to participate

The local committee named “ethic committee of the cardiovascular department” approved the study.

All patients gave informed written consent.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Mid left ventricle T2 mapping. T2 mapping in short axis at mid level without contouring (a) and with manual contouring (b) to define a region of interest (ROI) per segment
Fig. 2
Fig. 2
ROC curves of T2 mapping. ROC = receiver-operating characteristic; AUC = area under the curve; ECV = extracellular volume fraction
Fig. 3
Fig. 3
ROC curves of ECV. ROC = receiver-operating characteristic; AUC = area under the curve; ECV = extracellular volume fraction
Fig. 4
Fig. 4
Schematic workflow applied in our population based on 2 pathways: T2 myocardial mapping supplemented by ECV measurement (a) and ECV supplemented by T2 mapping (b) on the basal level of the left ventricle. ECV = extracellular volume fraction
See this image and copyright information in PMC

References

    1. Chambers DC, Yusen RD, Cherikh WS, Goldfarb SB, Kucheryavaya AY, Khusch K, et al. The Registry of the International Society for Heart and Lung Transplantation: Thirty-fourth Adult Lung And Heart-Lung Transplantation Report-2017; Focus Theme: Allograft ischemic time. J Heart Lung Transplant Off Publ Int Soc Heart Transplant. 2017;36:1047–59. - PubMed
    1. Kofler S, Bigdeli AK, Kaczmarek I, Kellerer D, Müller T, Schmoeckel M, et al. Long-term outcomes after 1000 heart transplantations in six different eras of innovation in a single center. Transpl Int Off J Eur Soc Organ Transplant. 2009;22:1140–1150. doi: 10.1111/j.1432-2277.2009.00931.x. - DOI - PubMed
    1. Patel JK, Kobashigawa JA. Should we be doing routine biopsy after heart transplantation in a new era of anti-rejection? Curr Opin Cardiol. 2006;21:127–131. doi: 10.1097/01.hco.0000210309.71984.30. - DOI - PubMed
    1. Yun KL, Niczyporuk MA, Daughters GT, Ingels NB, Stinson EB, Alderman EL, et al. Alterations in left ventricular diastolic twist mechanics during acute human cardiac allograft rejection. Circulation. 1991;83:962–973. doi: 10.1161/01.CIR.83.3.962. - DOI - PubMed
    1. Costanzo MR, Dipchand A, Starling R, Anderson A, Chan M, Desai S, et al. The International Society of Heart and Lung Transplantation Guidelines for the care of heart transplant recipients. J Heart Lung Transplant Off Publ Int Soc Heart Transplant. 2010;29:914–956. doi: 10.1016/j.healun.2010.05.034. - DOI - PubMed