Braggion-Santos Maria Fernanda, Lossnitzer Dirk, Buss Sebastian, Lehrke Stephanie, Doesch Andreas, Giannitsis Evangelos, Korosoglou Grigorios, Katus Hugo A, Steen Henning
Department of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg 69120, Germany School of Medicine of Ribeirao Preto, University of Sao Paulo, Sao Paulo, Brazil.
Department of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg 69120, Germany.
Eur Heart J Cardiovasc Imaging. 2014 Oct;15(10):1125-32. doi: 10.1093/ehjci/jeu090. Epub 2014 Jun 7.
Cardiac allograft vasculopathy (CAV), which limits long-term survival after heart transplantation (HTX), is usually evaluated by coronary angiography (CA). Late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) is a non-invasive technique that can detect CAV-related myocardial infarctions. We aimed to investigate the presence of LGE infarct-typical patterns in a large sample of HTX recipients and to correlate these findings with the severity of CAV assessed by CA.
LGE-CMR was performed in 132 HTX patients on a 1.5-T MRI scanner (Philips, Best, the Netherlands). Infarct-typical LGE areas were identified as bright lesions with subendocardial involvement. Infarct-atypical LGE was classified as follows: (i) right ventricle (RV) insertion, (ii) intramural, (iii) epicardial, and (iv) diffuse. CA was performed for the assessment of CAV (CAV0 = no lesion, CAV1 = mild lesions, CAV2 = moderate lesions, CAV3 = severe lesions, or mild/moderate lesions with allograft dysfunction). Infarct-typical LGE patterns were detected in 29 (22%) patients distributed in all groups and they were already present in nearly every fifth CAV0 patient, increasing significantly among CAV groups (CAV0 = 19%, CAV1 = 10%, CAV2 = 36%, and CAV3 = 71%; P < 0.01).
LGE-CMR was useful to identify myocardial scar possibly related to early CAV in a significant proportion of HTX recipients, otherwise classified as low-risk patients based on CA. Therefore, LGE-CMR could be helpful to intensify CAV monitoring, medical therapy, and clinical risk stratification.
心脏移植血管病变（CAV）限制了心脏移植（HTX）后的长期生存，通常通过冠状动脉造影（CA）进行评估。延迟钆增强心脏磁共振成像（LGE-CMR）是一种可检测CAV相关心肌梗死的非侵入性技术。我们旨在研究大量HTX受者中LGE梗死典型模式的存在情况，并将这些发现与通过CA评估的CAV严重程度相关联。
对132例HTX患者使用1.5-T MRI扫描仪（飞利浦，荷兰贝斯特）进行LGE-CMR检查。梗死典型的LGE区域被识别为累及心内膜下的明亮病变。梗死非典型LGE分类如下：（i）右心室（RV）插入，（ii）壁内，（iii）心外膜，以及（iv）弥漫性。进行CA以评估CAV（CAV0 =无病变，CAV1 =轻度病变，CAV2 =中度病变，CAV3 =重度病变，或伴有移植物功能障碍的轻度/中度病变）。在所有组中分布的29例（22%）患者中检测到梗死典型LGE模式，几乎每五分之一的CAV0患者中就已存在，在CAV组中显著增加（CAV0 = 19%，CAV1 = 10%，CAV2 = 36%，CAV3 = 71%；P < 0.01）。
LGE-CMR有助于在相当比例的HTX受者中识别可能与早期CAV相关的心肌瘢痕，否则根据CA这些患者会被归类为低风险患者。因此，LGE-CMR有助于加强CAV监测、药物治疗和临床风险分层。
