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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.

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.

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Magnetic resonance imaging of patient number 6 (short axis) showing a signal enhancement of the septal (arrow) and slightly of the basolateral region (arrow) of the left ventricular myocardium (late enhancement, segmental inversion recovery - TurboFLASH 2D image). RV: right ventricle. LV: left ventricle.
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Figure 3: Magnetic resonance imaging of patient number 6 (short axis) showing a signal enhancement of the septal (arrow) and slightly of the basolateral region (arrow) of the left ventricular myocardium (late enhancement, segmental inversion recovery - TurboFLASH 2D image). RV: right ventricle. LV: left ventricle.

Mentions: We found three different pattern of late contrast enhancement in the left ventricle (Table 1): none in patient no. 4 (Figure 2) and 7, slight or focal late contrast enhancement in patient no. 6 (Figure 3) and diffuse late contrast enhancement in patient no. 1 (Figure 4), 2, 3 and 9.


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)

Magnetic resonance imaging of patient number 6 (short axis) showing a signal enhancement of the septal (arrow) and slightly of the basolateral region (arrow) of the left ventricular myocardium (late enhancement, segmental inversion recovery - TurboFLASH 2D image). RV: right ventricle. LV: left ventricle.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: Magnetic resonance imaging of patient number 6 (short axis) showing a signal enhancement of the septal (arrow) and slightly of the basolateral region (arrow) of the left ventricular myocardium (late enhancement, segmental inversion recovery - TurboFLASH 2D image). RV: right ventricle. LV: left ventricle.
Mentions: We found three different pattern of late contrast enhancement in the left ventricle (Table 1): none in patient no. 4 (Figure 2) and 7, slight or focal late contrast enhancement in patient no. 6 (Figure 3) and diffuse late contrast enhancement in patient no. 1 (Figure 4), 2, 3 and 9.

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