Detection and prediction of acute heart transplant rejection with the myocardial T2determination provided by a black-blood magnetic resonance imaging sequence

Marié, Pierre; Angioı̈, Michaël; Carteaux, Jean‐Pierre; Escanyé, Jean Marie; Mattei, S; Tzvetanov, Kiril; Claudon, O.; Hassan, Nathalie; Danchin, Nicolás; Karcher, Gilles; Bertrand, Alain; Walker, Paul; Villemot, Jean Pierre

doi:10.1016/s0735-1097(00)01196-7

Cited by 144 publications

(34 citation statements)

References 15 publications

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“…In a recent study by Usman et al [14], ACAR was associated with elevated myocardial T 2 , which is in keeping with the findings of an early CMR study by Marie et al [21]. However, there are important differences between these studies and the current study.…”

Section: Discussionsupporting

confidence: 89%

Multiparametric cardiovascular magnetic resonance surveillance of acute cardiac allograft rejection and characterisation of transplantation-associated myocardial injury: a pilot study

Miller

Naish

Shaw

et al. 2014

Journal of Cardiovascular Magnetic Resonance

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BackgroundSerial surveillance endomyocardial biopsies are performed in patients who have recently undergone heart transplantation in order to detect acute cardiac allograft rejection (ACAR) before symptoms occur, however the biopsy process is associated with a number of limitations. This study aimed to prospectively and longitudinally evaluate the performance of multiparametric cardiovascular magnetic resonance (CMR) for detecting and monitoring ACAR in the early phase post-transplant, and characterize graft recovery following transplantation.MethodsAll patients receiving a heart transplant at a single UK centre over a period of 25 months were approached within one month of transplantation. Multiparametric CMR was prospectively performed on the same day as biopsy on four separate occasions (6 weeks, 10 weeks, 15 weeks and 20 weeks post-transplant). CMR included assessment of global and regional ventricular function, myocardial tissue characterization (T1 mapping, T2 mapping, extracellular volume, LGE) and pixel-wise absolute myocardial blood flow quantification. CMR parameters were compared with biopsy findings. As is standard, grade 2R or higher ACAR was considered significant.Results88 CMR-matched biopsies were performed in 22 patients. Eight (9%) biopsies in 5 patients demonstrated significant ACAR. Significant ACAR was associated with a reduction in circumferential strain (−12.7 ± 2.5% vs. -13.7 ± 3.6%, p = 0.047) but there was considerable overlap between groups. Whilst trends were observed between ACAR and proposed CMR markers of oedema, particularly after adjusting for primary graft dysfunction, differences were not significant. Significant improvements were seen in markers of graft structure and contractility, oedema and microvascular function over the period studied, although few parameters normalised.ConclusionsThis study provides novel insight into the myocardial injury associated with transplantation, and its recovery, however multiparametric CMR was not able to accurately detect ACAR during the early phase post-transplantation.

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Section: Discussionsupporting

confidence: 89%

Multiparametric cardiovascular magnetic resonance surveillance of acute cardiac allograft rejection and characterisation of transplantation-associated myocardial injury: a pilot study

Miller

Naish

Shaw

et al. 2014

Journal of Cardiovascular Magnetic Resonance

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“…Several studies could confirm a significant increase in absolute T2-values [23–25] or relative T2-signal [20] intensity in patients with ACR. But initial studies by Lund and Smart et al were limited by the very small number of patients [20, 24] and undefined histological grading [24].…”

Section: Discussionmentioning

confidence: 99%

“…Two studies by Marie et al included more patients and a histological grading according to the ISHLT recommendations [23, 25], just as the study presented here. While identical imaging parameters were used, the more recent study included a larger number of examinations (128 vs. 52).…”

Section: Discussionmentioning

confidence: 99%

“…While identical imaging parameters were used, the more recent study included a larger number of examinations (128 vs. 52). Both studies found the same sensitivity of 89 % for the detection of ACR (defined as a histological grade ≥2) with a specificity of 91 % [23] and 70 % [25], respectively. From our data, a lower sensitivity of 67 % and similar specificity of 73 % for the detection of histological grade ≥2 could be calculated.…”

Section: Discussionmentioning

confidence: 99%

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Assessment of sub-clinical acute cellular rejection after heart transplantation: comparison of cardiac magnetic resonance imaging and endomyocardial biopsy

et al. 2014

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ObjectiveComparing the diagnostic value of multi-sequential cardiac magnetic resonance imaging (CMR) with endomyocardial biopsy (EMB) for sub-clinical cardiac allograft rejection.MethodsOne hundred and forty-six examinations in 73 patients (mean age 53 ± 12 years, 58 men) were performed using a 1.5 Tesla system and compared to EMB. Examinations included a STIR (short tau inversion recovery) sequence for calculation of edema ratio (ER), a T1-weighted spin-echo sequence for assessment of global relative enhancement (gRE), and inversion-recovery sequences to visualize late gadolinium enhancement (LGE). Histological grade ≥1B was considered relevant rejection.ResultsOne hundred and twenty-seven (127/146 = 87 %) EMBs demonstrated no or mild signs of rejection (grades ≤1A) and 19/146 (13 %) a relevant rejection (grade ≥1B). Sensitivity, specificity, positive predictive, and negative predictive values were as follows: ER: 63 %, 78 %, 30 %, and 93 %; gRE: 63 %, 70 %, 24 %, and 93 %; LGE: 68 %, 36 %, 13 %, and 87 %; with the combination of ER and gRE with at least one out of two positive: 84 %, 57 %, 23 %, and 96 %. ROC analysis revealed an area under the curve of 0.724 for ER and 0.659 for gRE.ConclusionCMR parameters for myocarditis are useful to detect sub-clinical acute cellular rejection after heart transplantation. Comparable results to myocarditis can be achieved with a combination of parameters.Key Points• Magnetic resonance imaging is useful for the assessment of cardiac allograft rejection.• CMR has a high negative predictive value for exclusion of allograft rejection.• Diagnostic performance is not yet good enough to replace endomyocardial biopsy.

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“…Our early results did not reveal increased signal intensity on T2-weighted imaging in patients with ACR. T2 mapping is another approach to myocardial edema which has yielded promising results in adult ACR[19,26-28], but this technique was not available to us at the time of the study. When discussing the lack of agreement between CMR markers and histological indicators of ACR, important shortcomings of EMB as the gold standard for the detection of ACR must be considered.…”

Section: Discussionmentioning

confidence: 99%

Magnetic resonance imaging of the transplanted pediatric heart as a potential predictor of rejection

Greenway¹,

Dallaire²,

Kantor³

et al. 2016

WJT

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AIMTo evaluate cardiac magnetic resonance imaging (CMR) as a non-invasive tool to detect acute cellular rejection (ACR) in children after heart transplant (HT).METHODSThirty pediatric HT recipients underwent CMR at the time of surveillance endomyocardial biopsy (EMB) and results were compared to 14 non-transplant controls. Biventricular volumes, ejection fractions (EFs), T2-weighted signal intensities, native T1 times, extracellular volumes (ECVs) and presence of late gadolinium enhancement (LGE) were compared between patients and controls and between patients with International Society of Heart and Lung Transplantation (ISHLT) grade ≥ 2R rejection and those with grade 0/1R. Heart rate (HR) and brain natriuretic peptide (BNP) were assessed as potential biomarkers.RESULTSSignificant ACR (ISHLT grade ≥ 2R) was an infrequent event in our population (5/30, 17%). Ventricular volumes, EFs, LGE prevalence, ECVs, native T1 times, T2 signal intensity ratios, HR and BNP were not associated with the presence of ≥ 2R ACR.CONCLUSIONIn this pilot study CMR did not reliably identify ACR-related changes in pediatric HT patients.

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Detection and prediction of acute heart transplant rejection with the myocardial T2determination provided by a black-blood magnetic resonance imaging sequence

Abstract: Myocardial T2 determined using a black-blood MRI sequence, is sufficiently sensitive to identify most of the moderate acute rejections documented with biopsy at the same time, but is also a predictor of the subsequent occurrence of such biopsy-defined rejections.

Cited by 144 publications

References 15 publications

Multiparametric cardiovascular magnetic resonance surveillance of acute cardiac allograft rejection and characterisation of transplantation-associated myocardial injury: a pilot study

Multiparametric cardiovascular magnetic resonance surveillance of acute cardiac allograft rejection and characterisation of transplantation-associated myocardial injury: a pilot study

Assessment of sub-clinical acute cellular rejection after heart transplantation: comparison of cardiac magnetic resonance imaging and endomyocardial biopsy

Magnetic resonance imaging of the transplanted pediatric heart as a potential predictor of rejection

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