Alfred Heart Centre and Baker IDI Heart and Diabetes Research Institute, Heart Centre, Alfred Hospital, Commercial Road, Melbourne 3004, Australia.
Eur J Heart Fail. 2010 Jan;12(1):45-51. doi: 10.1093/eurjhf/hfp174.
We evaluated cardiac magnetic resonance imaging (CMR) as a non-invasive test for cardiac allograft rejection.
We performed CMR on 50 heart-transplant recipients. Acute rejection was confirmed in 11 cases by endomyocardial biopsy (EMB) and presumed in 8 cases with a recent fall in left-ventricular ejection fraction (LVEF) not attributable to coronary allograft vasculopathy. Control patients had both normal LVEF and no significant rejection on EMB. Cardiac magnetic resonance imaging evaluated myocardial function, oedema, and early and late post-Gadolinium-DTPA contrast enhancement. Patients with confirmed rejection demonstrated elevated early relative myocardial contrast enhancement (4.1 +/- 0.3 vs. 2.8 +/- 0.2, P < 0.001) and a trend to higher oedema suggested by higher relative myocardial intensity on T(2)-weighted imaging compared to controls (2.1 +/- 0.1 vs. 1.7 +/- 0.1, P = 0.1). With rejection defined as increased early contrast enhancement or myocardial oedema, the sensitivity and specificity of CMR compared with EMB were 100 and 73%, respectively. Eight patients with presumed rejection also had elevated early myocardial contrast enhancement compared with controls, (8.7 +/- 1.9 vs. 2.8 +/- 0.2, P < 0.05), which reduced following increased immunosuppression (8.7 +/- 1.9 vs. 4.6 +/- 1.2, P < 0.05). In these patients LVEF improved following increased immunosuppression (32 +/- 5 vs. 46 +/- 5%, P < 0.05).
Cardiac magnetic resonance imaging is a promising modality for non-invasive detection of cardiac allograft rejection.
我们评估心脏磁共振成像（CMR）作为心脏移植排斥的非侵入性检测方法。
我们对 50 例心脏移植受者进行了 CMR。通过心内膜心肌活检（EMB）证实 11 例为急性排斥反应，8 例因左心室射血分数（LVEF）近期下降且不能归因于冠状动脉移植血管病而推测为排斥反应。对照组的 LVEF 均正常且 EMB 无明显排斥反应。心脏磁共振成像评估了心肌功能、水肿以及钆-DTPA 对比剂增强的早期和晚期。经 EMB 证实的排斥反应患者表现出升高的早期相对心肌对比增强（4.1 ± 0.3 对 2.8 ± 0.2，P < 0.001）和 T2 加权成像上相对心肌强度升高提示的水肿趋势更高（2.1 ± 0.1 对 1.7 ± 0.1，P = 0.1）。以早期对比增强或心肌水肿增加定义为排斥反应，与 EMB 相比，CMR 的敏感性和特异性分别为 100%和 73%。8 例推测为排斥反应的患者与对照组相比，早期心肌对比增强也升高（8.7 ± 1.9 对 2.8 ± 0.2，P < 0.05），随着免疫抑制增加而降低（8.7 ± 1.9 对 4.6 ± 1.2，P < 0.05）。在这些患者中，随着免疫抑制增加，LVEF 得到改善（32 ± 5 对 46 ± 5%，P < 0.05）。
心脏磁共振成像作为心脏移植排斥的非侵入性检测方法具有广阔的应用前景。
