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The challenge to detect heart transplant rejection and transplant vasculopathy non-invasively - a pilot study.

Usta E, Burgstahler C, Aebert H, Schroeder S, Helber U, Kopp AF, Ziemer G - J Cardiothorac Surg (2009)

Bottom Line: Cardiac allograft rejection and vasculopathy are the main factors limiting long-term survival after heart transplantation.In this pilot study we investigated whether non-invasive methods are beneficial to detect cardiac allograft rejection (Grade 03 R) and cardiac allograft vasculopathy.Late contrast enchancement found by magnetic resonance imaging correlated positively (r = 0.92, r2 = 0.85, p < 0.05) with the histological diagnosis of transplant rejection revealed by myocardial biopsy.None of the examined endomyocardial specimen revealed cardiac allograft rejection greater than Grade 1 R.

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Affiliation: Department of Thoracic-, Cardiac- and Vascular Surgery, Tübingen University Hospital, Germany. engin.usta@med.uni-tuebingen.de

ABSTRACT

Background: Cardiac allograft rejection and vasculopathy are the main factors limiting long-term survival after heart transplantation.In this pilot study we investigated whether non-invasive methods are beneficial to detect cardiac allograft rejection (Grade 03 R) and cardiac allograft vasculopathy. Thus we compared multi-slice computed tomography and magnetic resonance imaging with invasive methods like coronary angiography and left endomyocardial biopsy.

Methods: 10 asymptomatic long-term survivors after heart transplantation (8 male, 2 female, mean age 52.1 +/- 12 years, 73 +/- 11 months after transplantation) were included. In a blinded fashion, coronary angiography and multi-slice computed tomography and ventricular endomyocardial biopsy and magnetic resonance imaging were compared against each other.

Results: Cardiac allograft vasculopathy and atherosclerosis were correctly detected by multi-slice computed tomography and coronary angiography with positive correlation (r = 1). Late contrast enchancement found by magnetic resonance imaging correlated positively (r = 0.92, r2 = 0.85, p < 0.05) with the histological diagnosis of transplant rejection revealed by myocardial biopsy. None of the examined endomyocardial specimen revealed cardiac allograft rejection greater than Grade 1 R.

Conclusion: A combined non-invasive approach using multi-slice computed tomography and magnetic resonance imaging may help to assess cardiac allograft vasculopathy and cardiac allograft rejection after heart transplantation before applying more invasive methods.

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A: Coronary angiogram showing the stenosis of the left main stem in patient number 2 (arrow, LAO: left anterior oblique). B: Multi-slice computed tomography of the same patient with the corresponding stenosis (arrow, MIP: maximal intensity projection). Ao: aorta, LA: left atrium, LM: left main artery, CX: circumflex artery.
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Figure 1: A: Coronary angiogram showing the stenosis of the left main stem in patient number 2 (arrow, LAO: left anterior oblique). B: Multi-slice computed tomography of the same patient with the corresponding stenosis (arrow, MIP: maximal intensity projection). Ao: aorta, LA: left atrium, LM: left main artery, CX: circumflex artery.

Mentions: By coronary angiography and multi-slice spiral computed tomography lesions in the epimyocardial vessel segments could be correctly detected in all patients (Table 1). 2 patients showed diffuse atherosclerotic lesions (patient no. 5 Calcium mass 0.81 in mg CaHa, patient no. 9 Calcium mass 11.3 in mg CaHa) and coronary artery disease was diagnosed in 2 patients (patient no. 2: stenosis of the left main stem and left anterior descending artery (Figure 1), Calcium mass 0.13 in mg CaHa; patient no. 10: stenosis of the left anterior descending artery which was treated 5 days later by percutaneous coronary intervention. Patient no. 2 was meanwhile also treated by percutaneous coronary intervention. The complications after coronary angiography were haematoma of the groin in 2 patients and pericardial effusion in 2 patients, which could be managed conservatively. After multi-slice spiral computed tomography no complications occurred.


The challenge to detect heart transplant rejection and transplant vasculopathy non-invasively - a pilot study.

Usta E, Burgstahler C, Aebert H, Schroeder S, Helber U, Kopp AF, Ziemer G - J Cardiothorac Surg (2009)

A: Coronary angiogram showing the stenosis of the left main stem in patient number 2 (arrow, LAO: left anterior oblique). B: Multi-slice computed tomography of the same patient with the corresponding stenosis (arrow, MIP: maximal intensity projection). Ao: aorta, LA: left atrium, LM: left main artery, CX: circumflex artery.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2735733&req=5

Figure 1: A: Coronary angiogram showing the stenosis of the left main stem in patient number 2 (arrow, LAO: left anterior oblique). B: Multi-slice computed tomography of the same patient with the corresponding stenosis (arrow, MIP: maximal intensity projection). Ao: aorta, LA: left atrium, LM: left main artery, CX: circumflex artery.
Mentions: By coronary angiography and multi-slice spiral computed tomography lesions in the epimyocardial vessel segments could be correctly detected in all patients (Table 1). 2 patients showed diffuse atherosclerotic lesions (patient no. 5 Calcium mass 0.81 in mg CaHa, patient no. 9 Calcium mass 11.3 in mg CaHa) and coronary artery disease was diagnosed in 2 patients (patient no. 2: stenosis of the left main stem and left anterior descending artery (Figure 1), Calcium mass 0.13 in mg CaHa; patient no. 10: stenosis of the left anterior descending artery which was treated 5 days later by percutaneous coronary intervention. Patient no. 2 was meanwhile also treated by percutaneous coronary intervention. The complications after coronary angiography were haematoma of the groin in 2 patients and pericardial effusion in 2 patients, which could be managed conservatively. After multi-slice spiral computed tomography no complications occurred.

Bottom Line: Cardiac allograft rejection and vasculopathy are the main factors limiting long-term survival after heart transplantation.In this pilot study we investigated whether non-invasive methods are beneficial to detect cardiac allograft rejection (Grade 03 R) and cardiac allograft vasculopathy.Late contrast enchancement found by magnetic resonance imaging correlated positively (r = 0.92, r2 = 0.85, p < 0.05) with the histological diagnosis of transplant rejection revealed by myocardial biopsy.None of the examined endomyocardial specimen revealed cardiac allograft rejection greater than Grade 1 R.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Thoracic-, Cardiac- and Vascular Surgery, Tübingen University Hospital, Germany. engin.usta@med.uni-tuebingen.de

ABSTRACT

Background: Cardiac allograft rejection and vasculopathy are the main factors limiting long-term survival after heart transplantation.In this pilot study we investigated whether non-invasive methods are beneficial to detect cardiac allograft rejection (Grade 03 R) and cardiac allograft vasculopathy. Thus we compared multi-slice computed tomography and magnetic resonance imaging with invasive methods like coronary angiography and left endomyocardial biopsy.

Methods: 10 asymptomatic long-term survivors after heart transplantation (8 male, 2 female, mean age 52.1 +/- 12 years, 73 +/- 11 months after transplantation) were included. In a blinded fashion, coronary angiography and multi-slice computed tomography and ventricular endomyocardial biopsy and magnetic resonance imaging were compared against each other.

Results: Cardiac allograft vasculopathy and atherosclerosis were correctly detected by multi-slice computed tomography and coronary angiography with positive correlation (r = 1). Late contrast enchancement found by magnetic resonance imaging correlated positively (r = 0.92, r2 = 0.85, p < 0.05) with the histological diagnosis of transplant rejection revealed by myocardial biopsy. None of the examined endomyocardial specimen revealed cardiac allograft rejection greater than Grade 1 R.

Conclusion: A combined non-invasive approach using multi-slice computed tomography and magnetic resonance imaging may help to assess cardiac allograft vasculopathy and cardiac allograft rejection after heart transplantation before applying more invasive methods.

Show MeSH
Related in: MedlinePlus