Reduced myocardial perfusion reserve and transmural perfusiongradient in heart transplant arteriopathyassessed by magnetic resonance imaging

Muehling, Olaf; Wilke, Norbert; Panse, Prasad M.; Jerosch‐Herold, Michael; Wilson, Betsy; Wilson, Thomine; Miller, Leslie W.

doi:10.1016/s0735-1097(03)00924-0

Cited by 122 publications

(71 citation statements)

References 21 publications

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“…Although to the best of our knowledge the present study is the first on CFR by CE-TTE, CFR has been previously studied in HT patients by other methods (3,(12)(13)(14)(15)(16).…”

Section: Cfr In Ht: Ce-tte Versus Other Methodsmentioning

confidence: 97%

“…The discrepancy may relate to: small sample size and/or very few patients with CAV (13,15), selection bias due to technical difficulty in performing the invasive measurements in severe CAV (14), various definitions of CAV by angiography (13,14) and/or by IVUS (14,15). In addition, noninvasive studies, which failed to show a correlation between the reduced CFR and CAV, used positron emission tomography (15) or MRPI (13), therefore they are not comparable with CE-TTE.…”

Section: Cfr In Ht: Ce-tte Versus Other Methodsmentioning

confidence: 99%

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Coronary Flow Reserve by Contrast-Enhanced Echocardiography: A New Noninvasive Diagnostic Tool for Cardiac Allograft Vasculopathy

Tona

Caforio

Montisci

et al. 2006

American Journal of Transplantation

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Noninvasive tests have proven unsatisfactory in cardiac allograft vasculopathy (CAV) diagnosis. We assessed coronary flow reserve (CFR) by contrastenhanced transthoracic echocardiography (CE-TTE) in heart transplantation (HT). CFR was assessed in the left anterior descending coronary artery in 73 HT recipients (59 male, aged 50 ± 12 years at HT), at 8 ± 4.5 years post-HT. CFR measurements were taken blindly from coronary angiographies. CFR cut points were the standard value of ≤2 and those defined by receiver operating characteristics (ROC) curve analysis. CFR was lower in patients with CAV (2.3 ± 0.7 vs. 3.2 ± 0.5, p < 0.0001). The ≤2 cut point was 100% specific and 38% sensitive. The ≤2.7 cut point, optimal by ROC analysis, was 87% specific and 82% sensitive. Accuracy rose from 71% with the standard ≤2 cut point to 85% with the optimal cut point of ≤2.7. CFR by CE-TTE may offer promise as a novel, easily repeatable and accurate noninvasive tool in CAV detection. However, further longitudinal studies in larger patient cohorts are warranted before widespread adoption can be advocated.

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“…Although to the best of our knowledge the present study is the first on CFR by CE-TTE, CFR has been previously studied in HT patients by other methods (3,(12)(13)(14)(15)(16).…”

Section: Cfr In Ht: Ce-tte Versus Other Methodsmentioning

confidence: 97%

Section: Cfr In Ht: Ce-tte Versus Other Methodsmentioning

confidence: 99%

Coronary Flow Reserve by Contrast-Enhanced Echocardiography: A New Noninvasive Diagnostic Tool for Cardiac Allograft Vasculopathy

Tona

Caforio

Montisci

et al. 2006

American Journal of Transplantation

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“…Unfortunately, microvascular disease in this study could not be assessed. They also demonstrated that patients with CAV have a reduced myocardial perfusion even during rest conditions [114] . In regards to CMR tissue characterization, Steen et al [115] showed that more than 80% of patients with severe angiographic CAV had a late gadolinium enhancement pattern suggesting subendocardial infarction with a distribution consistent with the angiographic pattern.…”

Section: Cardiac Magnetic Resonance Imagingmentioning

confidence: 95%

“…The use of adenosine for myocardium stress perfusion after heart transplantation has not been widely reported. Nevertheless, Muehling et al [114] showed a reduced myocardial perfusion reserve in patients with CAV with good correlation between MRI and invasive measurements. Unfortunately, microvascular disease in this study could not be assessed.…”

Section: Cardiac Magnetic Resonance Imagingmentioning

confidence: 99%

Diagnosis and management of coronary allograft vasculopathy in children and adolescents

Dedieu

Greil

Wong

et al. 2014

WJT

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Coronary allograft vasculopathy remains one of the leading causes of death beyond the first year post transplant. As a result of denervation following transplantation, patients lack ischaemic symptoms and presentation is often late when the graft is already compromised. Current diagnostic tools are rather invasive, or in case of angiography, significantly lack sensitivity. Therefore a non-invasive tool that could allow early diagnosis would be invaluable.This paper review the disease form its different diagnosis techniques,including new and less invasive diagnostic tools to its pharmacological management and possible treatments. DEFINITION AND PHYSIOPATHOLOGYIn children, coronary allograft vasculopathy (CAV) remains the main limiting survival factor after heart transplantation and the major cause of mortality after the first year post transplant leading ultimately to graft loss [1,2] . One elegant etiological description of CAV is that of "immunologic mechanisms operating in a milieu of nonimmunologic risk factors" [3] . The process is believed to start off as a response to endothelial injury in the graft, originated by a complex interaction of multiple donor and recipient factors. The resulting endothelial dysfunction, leads to altered endothelial permeability and subsequent intimal hyperplasia as a consequence of the vascular remodeling originated by the inflammatory response. The immunologic events constitute the original trigger and noninflammatory events such as cytomegalovirus infection, ischemic time (reperfusion injury), increased donor age and classical cardiovascular risk factors (i.e., diabetes, dyslipidemias, smoking and hypertension), perpetuate the inflammatory response and increase the endothelial injury [4] . Typical lesions (Figures 1 and 2) consist of diffuse intimal proliferation leading to the development of luminal stenosis and small vessels occlusion which then limits blood supply to the graft causing chronic vascular injury and ultimately myocardial ischemia [5] . The lesions develop earlier and quicker than atherosclerotic lesions. REVIEW 276December 24, 2014|Volume 4|Issue 4|

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“…Magnetic resonance coronary angiography, at present, shows limited sensitivity for detecting CAV and positron emission tomography (PET) has not yet been well studied (Muehling et al, 2003).…”

Section: Ivus Parameters Include Intimal Thickness Intimal Index Anmentioning

confidence: 99%

Cardiac Allograft Vasculopathy: An Ongoing Challenge in the Care of Heart Transplant Recipients

Clarke¹,

Khush²

2012

Cardiac Transplantation

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Reduced myocardial perfusion reserve and transmural perfusiongradient in heart transplant arteriopathyassessed by magnetic resonance imaging

Abstract: Magnetic resonance perfusion imaging detects Tx-CHD by a decreased MPR. After exclusion of LV hypertrophy and prior rejection, resting Endo/Epi ratio alone might be sufficient to indicate Tx-CHD.

Cited by 122 publications

References 21 publications

Coronary Flow Reserve by Contrast-Enhanced Echocardiography: A New Noninvasive Diagnostic Tool for Cardiac Allograft Vasculopathy

Coronary Flow Reserve by Contrast-Enhanced Echocardiography: A New Noninvasive Diagnostic Tool for Cardiac Allograft Vasculopathy

Diagnosis and management of coronary allograft vasculopathy in children and adolescents

Cardiac Allograft Vasculopathy: An Ongoing Challenge in the Care of Heart Transplant Recipients

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