Detection and prediction of acute heart transplant rejection with the myocardial T2 determination provided by a black-blood magnetic resonance imaging sequence

Marie, P. Y.; Carteaux, Jean‐Pierre; Escanyé, Jean Marie; Claudon, O.; David, N.; Mattei, S; Hassan, Neelam; Danchin, N.; Karcher, Gilles; Bertrand, Alain; Villemot, Jean Pierre

doi:10.1016/s1053-2498(00)00406-x

Cited by 37 publications

(55 citation statements)

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“…LGE-CMRI is non-invasive, radiation free and has been extensively validated for its ability to identify even small areas of myocardial necrosis [12][13][14], with a good correlation with histopathological findings. It can also identify regions of myocardial damage that may be due not only to myocardial infarction but also to a variety of other conditions such as myocarditis, sarcoidosis and acute rejection post-cardiac transplantation [15][16][17].…”

Section: Discussionmentioning

confidence: 99%

Troponin-positive chest pain with unobstructed coronary arteries: definitive differential diagnosis using cardiac MRI

Mahmoudi¹,

Harden²,

Abid³

et al. 2012

The British Journal of Radiology

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Objective: The purpose of this study was to assess the outcome of cardiac MRI (CMRI) with late gadolinium enhancement (LGE) at outpatient follow-up in a consecutive series of patients with troponin-positive chest pain but unobstructed coronary arteries at the index admission. Methods: The study group comprised 91 consecutive patients who presented to our institution with cardiac chest pain, elevated troponin I and unobstructed coronary arteries on coronary angiography. All patients underwent an outpatient CMRI with LGE imaging in order to establish a definitive diagnosis. Results: The average time from coronary angiography to LGE-CMRI was 2 months. 73% of patients had no abnormality on their LGE-CMRI, 16% of patients had patchy late enhancement consistent with myocarditis and 11% had focal subendocardial or full thickness late enhancement consistent with myocardial infarction. There were no deaths in this cohort during a mean follow-up of 21 months. Conclusion:LGE-CMRI is a useful tool for establishing whether such patients have definitive evidence of non-ST-segment elevation myocardial infarction (NSTEMI), and can make an important contribution to the long-term management strategy of these patients as an inappropriate diagnosis of NSTEMI carries important medical, social and financial implications.

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Section: Discussionmentioning

confidence: 99%

Troponin-positive chest pain with unobstructed coronary arteries: definitive differential diagnosis using cardiac MRI

Mahmoudi¹,

Harden²,

Abid³

et al. 2012

The British Journal of Radiology

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“…Cardiac magnetic resonance imaging (CMR) has been demonstrated in prior studies to identify both these features in the non-transplant population, 10,11 with at least one study also demonstrating increased myocardial oedema in acute cardiac allograft rejection. 12 Furthermore, multisequential CMR is an established non-invasive investigation for the diagnosis of acute myocarditis, 13 a condition that has some histological similarity to acute cellular rejection. 14 In this prospective study, we evaluated the efficacy of multisequential CMR in the diagnosis of acute cardiac allograft rejection.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic Performance of Multisequential Cardiac Magnetic Resonance Imaging in Acute Cardiac Allograft Rejection

Taylor

Vaddadi

Pflüger

et al. 2009

Heart, Lung and Circulation

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“…[14][15][16] Because there is evidence that myocardial edema correlates with acute transplant rejection, it stands that cardiac magnetic resonance (CMR) may also have some use in diagnosing this condition. [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] CMR T2 mapping has the added benefit of being able to quantify numerically the tissue T2 relaxation values. 32a,32b T2 values are known to be prolonged in tissues with high water content because of edema, for example in acute myocardial infraction and myocarditis.…”

mentioning

confidence: 99%

Cardiac Magnetic Resonance T2 Mapping in the Monitoring and Follow-up of Acute Cardiac Transplant Rejection

Usman

Taimen

Wasielewski

et al. 2012

Circ: Cardiovascular Imaging

108

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Background— Acute rejection is a major factor impacting survival in the first 12 months after cardiac transplantation. Transplant monitoring requires invasive techniques. Cardiac magnetic resonance (CMR), noninvasive testing, has been used in monitoring heart transplants. Prolonged T2 relaxation has been related to transplant edema and possibly rejection. We hypothesize that prolonged T2 reflects transplant rejection and that quantitative T2 mapping will concur with the pathological and clinical findings of acute rejection. Methods and Results— Patients were recruited within the first year after transplantation. Biopsies were graded according to the International Society for Heart Lung Transplant system for cellular rejection with immunohistochemistry for humoral rejection. Rejection was also considered if patients presented with signs and symptoms of hemodynamic compromise without biopsy evidence of rejection who subsequently improved with treatment. Patients underwent a novel single-shot T2-prepared steady-state free precession 4-chamber and 3 short axis sequences and regions of interest were drawn overlying T2 maps by 2 independent blinded reviewers. A total of 74 (68 analyzable) CMRs T2 maps in 53 patients were performed. There were 4 cellular, 2 humoral, and 2 hemodynamic rejection cases. The average T2 relaxation time for grade 0R (n=46) and grade 1R (n=17) was 52.5±2.2 and 53.1±3.3 ms (mean±SD), respectively. The average T2 relaxation for grade 2R (n=3) was 59.6±3.1 ms and 3R (n=1) was 60.3 ms (all P value <0.05 compared with controls). The T2 average in humoral rejection cases (n=2) was 59.2±3.3 ms and the hemodynamic rejection (n=2) was 61.1±1.8 ms ( P <0.05 versus controls). The average T2 relaxation time for all-cause rejection versus no rejection is 60.1±2.1 versus 52.8±2.7 ms ( P <0.05). All rejection cases were rescanned 2.5 months after treatment and demonstrated T2 normalization with average of 51.4±1.6 ms. No difference was found in ventricular function between nonrejection and rejection patients, except in ventricular mass 107.8±10.3 versus 127.5±10.4 g ( P < 0.05). Conclusions— Quantitative T2 mapping offers a novel noninvasive tool for transplant monitoring, and these initial findings suggest potential use in characterizing rejections. Given the limited numbers, a larger multi-institution study may help elucidate the benefits of T2 mapping as an adjunctive tool in routine monitoring of cardiac transplants.

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Detection and prediction of acute heart transplant rejection with the myocardial T2 determination provided by a black-blood magnetic resonance imaging sequence

Cited by 37 publications

References 0 publications

Troponin-positive chest pain with unobstructed coronary arteries: definitive differential diagnosis using cardiac MRI

Troponin-positive chest pain with unobstructed coronary arteries: definitive differential diagnosis using cardiac MRI

Diagnostic Performance of Multisequential Cardiac Magnetic Resonance Imaging in Acute Cardiac Allograft Rejection

Cardiac Magnetic Resonance T2 Mapping in the Monitoring and Follow-up of Acute Cardiac Transplant Rejection

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