Diagnostic performance of late gadolinium enhancement in the assessment of acute cellular rejection after heart transplantation

Şimşek, Evrim; Nalbantgil, Sanem; Ceylan, Naim; Zoghi, Mehdi; Kemal, Hatice; Engin, Çağatay; Yağdı, Tahir; Özbaran, Mustafa

doi:10.5152/anatoljcardiol.2015.5961

Cited by 9 publications

(5 citation statements)

References 23 publications

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“…Conversely, a small CMR study using T2-weighted signal intensities and native T1 times, extracellular volumes, and LGE did not reliably identify acute cellular rejection in children [52]. However, the study was likely underpowered to detect the outcome.…”

Section: Cmr Imagingmentioning

confidence: 90%

“…In another study by Hussain et al, 26 pediatric HT recipients underwent CTCA, IVUS, and stress CMR with tissue characterization, which showed that increasing T2 values were associated with worsening LV function and increasing T1/ECV and T2 values were associated with rejection burden and low-grade CAV [51]. However, LGE in adult HT recipients was not found to correlate with acute cellular rejection [52]. CMR imaging with quantitative T2 mapping offers a potential noninvasive method for screening pediatric HT patients for acute allograft rejection [53,54].…”

Section: Cmr Imagingmentioning

confidence: 99%

See 1 more Smart Citation

Multimodality Imaging to Detect Rejection, and Cardiac Allograft Vasculopathy in Pediatric Heart Transplant Recipients—An Illustrative Review

Das

Deshpande

Hussain³

2022

Transplantology

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The three most common modalities of graft surveillance in pediatric heart transplant (HT) recipients include echocardiography, coronary angiography, and endomyocardial biopsy (EMB). The survival outcomes after HT in children have improved considerably in recent years. However, allograft rejection and cardiac allograft vasculopathy remain the leading cause of death or re-transplantation. The routine surveillance by EMB and coronary angiography are invasive and risky. Newer noninvasive echocardiographic techniques, including tissue Doppler imaging (TDI), 2-D speckle tracking echocardiography, CT coronary angiography (CTCA), cardiovascular magnetic resonance (CMR), single-photon emission computed tomography (SPECT), and positron emission tomography (PET) and invasive techniques such as intravascular ultrasound (IVUS), functional flow reserve (CFR) of coronary arteries, optical coherence tomography (OCT), have emerged as powerful tools which may help early recognition of sub-clinical rejection, response to treatment, early detection, and progression of CAV. The multimodality imaging approach, including noninvasive and invasive tests, is the future for the transplanted heart to detect dysfunction, rejections, and early CAV. This review illustrates noninvasive and invasive imaging techniques currently used or could be considered for clinical use in detecting heart transplant rejection, dysfunction, and CAV in children.

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Section: Cmr Imagingmentioning

confidence: 90%

Section: Cmr Imagingmentioning

confidence: 99%

Multimodality Imaging to Detect Rejection, and Cardiac Allograft Vasculopathy in Pediatric Heart Transplant Recipients—An Illustrative Review

Das

Deshpande

Hussain³

2022

Transplantology

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“…Az ambuláns kontrollvizsgálat során végzett echokardiográfiás vizsgálat mindhárom beteg esetén csökkent bal kamra szisztolés funkciót írt le, amely hátterében akut rejekció gyanúja (16)(17)(18)(19)(20). A 2010-es ISHLT konszenzus konferencia előtt a biopszia negatív rejekciós betegek aránya 10-20% között mozgott, ami az AMR diagnosztikájának bevezetése után csökkent (21), de továbbra sem elhanyagolható mértékű.…”

Section: Saját Tapasztalataink a Városmajori Szív-és éRgyógyászati Klunclassified

“…A szívtranszplantált betegeknél megfigyelhető késői halmozás hátterében azonban az AR mellett allograft vasculopathia és reperfúziós károsodás is állhat (3). A rendelkezésünkre álló kevés irodalmi adat alapján a késői kontraszthalmozás és AR közötti viszony ellentmondásos, egyes cikkek nem találtak korrelációt a rejekció jelenléte és súlyossága, valamint a késői halmozás megléte között (3,14,19). Ezzel szemben Butler és munkatársai a HTX-betegek utánkövetése során a miokardiális heg jelenlétét a kardiovaszkuláris halálozás és hospitalizáció független prediktorának találták (39).…”

Section: T 1 -Súlyozott Mérésekunclassified

A szív MR-vizsgálat szerepe kevert típusú (humorális és celluláris) kardiális allograft rejekció esetén

Suhai¹,

Sax²,

Assabiny³

et al. 2018

Cardiologia Hungarica

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Az akut kardiális allograft rejekció a modern immunszuppresszív terápia ellenére jelenleg is az egyik vezető halálok szívtranszplantált betegek körében. Az akut rejekció kimutatásának referenciamódszere az endomiokardiális biopszia, azonban a noninvazív képalkotó diagnosztikus eljárások napjainkban e témában a tudományos kutatások fókuszába kerültek. A szív MR-(CMR) vizsgálat a bal és jobb kamra globális és regionális funkció meghatározásán túl szöveti karakterizációs képessége miatt kiemelkedik ezen modalitások közül. A kevert típusú (celluláris és humorális) rejekció ritka entitás, amelyről csak kevés irodalmi adat áll rendelkezésünkre, diagnosztikája sok esetben kihívást jelenthet. A kevert rejekció okozta CMR-eltérésekről nagyon korlátozottak az ismereteink. Az elmúlt évben három szívtranszplantált betegnél akut kevert típusú rejekciót diagnosztizáltunk, az elvégzett CMR-vizsgálat mindhárom beteg esetében nagyon hasonló eltéréseket mutatott. Egy beteg esetén kontroll CMR-vizsgálatokat is végeztünk, nyomon követve a bal és jobb kamrai ejekciós frakciók, volumenek, valamint az ödéma és késői kontraszthalmozás mintázatának változását a kezelés függvényében. A kutatás az "NVKP_16-1-2016-0017 számú projekt a Nemzeti Kutatási Fejlesztési és Innovációs Alapból biztosított támogatással, az NVKP_16 pályázati program finanszírozásában valósult meg. TheroleofCMRintheevaluationofacutemixedcardiacallograftrejectionDespite of the modern immunosuppressive therapy the acute cardiac allograft rejection is a leading cause of morbidity and mortality in heart transplant patients. Endomyocardial biopsy is considered the current gold standard for the diagnosis of acute cardiac rejection, nevertheless there is an intense research regarding on non-invasive diagnostic methods in this field. Cardiac magnetic resonance imaging (CMR) has an evolving role in the detection of acute rejection among these modalities because of its ability to quantify ventricular function and characterize the complete myocardial tissue. There are only few data of the mixed (cellular and humoral) rejection which is a very rare entity, and the diagnosis remains challenging. Our knowledge about the CMR findings of mixed cardiac rejection is limited as well. In the last year we have made a diagnosis of mixed cardiac rejection in three patients, and the subsequently performed CMR showed very similar features in each patients. We performed serial CMR examinations in one patient to follow-up the changes of left and right ventricular volumes, ejection fractions and the pattern of myocardial oedema and delayed contrast enhancement.

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“…Because ACR can be asymptomatic, its early detection requires active monitoring with serial endomyocardial biopsy (EMB), the gold standard for its diagnosis (7,8). However, this invasive approach poses a challenge because of its high cost and risk of complications such as RV perforation, cardiac tamponade, arrhythmia, pneumothorax, and tricuspid valve injury (3,(9)(10)(11). The currently accepted rejection classification after HT was proposed by the International Society of Heart and Lung Transplant (ISHLT) (12,13).…”

Section: ' Introductionmentioning

confidence: 99%

C-Reactive protein level and left ventricular mass are associated with acute cellular rejection after heart transplant

Bacal¹,

Fernandes-Silva²,

Mangini³

et al. 2021

Clinics

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Acute cellular rejection (ACR) remains a major complication of heart transplant (HT). The gold standard for its diagnosis is endomyocardial biopsy (EMB), whereas the role of non-invasive biomarkers for detecting ACR is unclear. This study aimed to identify non-invasive biomarkers for the diagnosis of ACR in patients undergoing HT and presenting with normal left ventricular function. METHODS: We evaluated patients who underwent HT at a single center between January 2010 and June 2019. Patients were enrolled after HT, and those with left ventricular (LV) systolic dysfunction before EMB were excluded. We included only the results of the first EMB performed at least 30 days after HT (median, 90 days). Troponin, B-type natriuretic peptide (BNP), and C-reactive protein (CRP) levels were measured and echocardiography was performed up to 7 days before EMB. ACR was defined as International Society for Heart and Lung Transplantation grade 2R or 3R on EMB. We performed logistic regression analysis to identify the non-invasive predictors of ACR (2R or 3R) and evaluated the accuracy of each using area under the receiver operator characteristic curve analysis. RESULTS: We analyzed 72 patients after HT (51.31±13.63 years; 25 [34.7%] women); of them, 9 (12.5%) developed ACR. Based on multivariate logistic regression analysis, we performed forward stepwise selection (entry criteria, po0.05). The only independent predictors that remained in the model were CRP level and LV mass index. The optimal cut-off point for CRP level was X15.9 mg/L (odds ratio [OR], 11.7; p=0.007) and that for LV mass index was X111 g/m 2 (OR, 13.6; p=0.003). The area under the receiver operating characteristic curve derived from this model was 0.87 (95% confidence interval [CI], 0.75-0.99), with sensitivity of 85.7% (95% CI, 42.1%-99.6%), specificity of 78.4% (95% CI, 64.7%-88.7%), positive predictive value of 35.3% (95% CI, 14.3%-61.7%), and negative predictive value of 97.6% (95% CI, 87.1%-99.9%). CONCLUSIONS: Among patients undergoing HT, CRP level and LV mass were directly associated with ACR, but troponin and BNP levels were not.

show abstract

Diagnostic performance of late gadolinium enhancement in the assessment of acute cellular rejection after heart transplantation

Cited by 9 publications

References 23 publications

Multimodality Imaging to Detect Rejection, and Cardiac Allograft Vasculopathy in Pediatric Heart Transplant Recipients—An Illustrative Review

Multimodality Imaging to Detect Rejection, and Cardiac Allograft Vasculopathy in Pediatric Heart Transplant Recipients—An Illustrative Review

A szív MR-vizsgálat szerepe kevert típusú (humorális és celluláris) kardiális allograft rejekció esetén

C-Reactive protein level and left ventricular mass are associated with acute cellular rejection after heart transplant

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