多参数心脏磁共振成像可检测心脏移植后急性心脏移植物排斥反应。
Multiparametric Cardiac Magnetic Resonance Imaging Can Detect Acute Cardiac Allograft Rejection After Heart Transplantation.
机构信息
Department of Radiology, Northwestern University, Chicago, Illinois.
Department of Radiology, Northwestern University, Chicago, Illinois.
出版信息
JACC Cardiovasc Imaging. 2019 Aug;12(8 Pt 2):1632-1641. doi: 10.1016/j.jcmg.2019.01.026. Epub 2019 Mar 13.
OBJECTIVES
The purpose of this study was to evaluate the sensitivity of multiparametric cardiac magnetic resonance imaging (CMR) for the detection of acute cardiac allograft rejection (ACAR).
BACKGROUND
ACAR is currently diagnosed by endomyocardial biopsy, but CMR may be a noninvasive alternative because of its capacity for regional myocardial structure and function characterization.
METHODS
Fifty-eight transplant recipients (mean age 47.0 ± 14.7 years) and 14 control subjects (mean age 47.7 ± 16.7 years) were prospectively recruited from August 2014 to May 2017 and underwent 97 CMR studies (83 transplant recipients, 14 control subjects) for assessment of global left ventricular function and myocardial T2, T1, and extracellular volume fraction (ECV). CMR studies were divided into 4 groups on the basis of biopsy grade: control subjects (n = 14), patients with no ACAR (no history of ACAR; n = 36), patients with past ACAR (history of ACAR; n = 24), and ACAR+ patients (active grade ≥1R ACAR; n = 23).
RESULTS
Myocardial T2 was significantly higher in patients with past ACAR compared with those with no ACAR (51.0 ± 3.8 ms vs. 49.2 ± 4.0 ms; p = 0.02) and in patients with no ACAR compared with control subjects (49.2 ± 4.0 ms vs. 45.2 ± 2.3 ms; p < 0.01). ACAR+ patients demonstrated increased T2 compared with the no ACAR group (52.4 ± 4.7 ms vs. 49.2 ± 4.0 ms, p < 0.01) but not compared with the past ACAR group. In contrast, ECV was significantly elevated in ACAR+ patients compared with transplant recipients without ACAR regardless of history of ACAR (no ACAR: 31.5 ± 3.9% vs. 26.8 ± 3.3% [p < 0.01]; past ACAR: 31.5 ± 3.9% vs. 26.8 ± 4.0% [p < 0.01]). Receiver operating characteristic curve analysis revealed that a combined model of age at CMR, global T2, and global ECV was predictive of ACAR (area under the curve = 0.84).
CONCLUSIONS
The combination of CMR-derived myocardial T2 and ECV has potential as a noninvasive tissue biomarker for ACAR. Larger studies during acute ACAR are needed for continued development of multiparametric CMR for transplant recipient surveillance.
目的
本研究旨在评估多参数心脏磁共振成像（CMR）在检测急性心脏移植物排斥（ACAR）中的敏感性。
背景
目前，ACAR 通过心内膜心肌活检诊断，但 CMR 可能是一种替代方法，因为它能够对局部心肌结构和功能进行特征描述。
方法
2014 年 8 月至 2017 年 5 月期间，前瞻性招募了 58 名移植受者（平均年龄 47.0 ± 14.7 岁）和 14 名对照者（平均年龄 47.7 ± 16.7 岁），并进行了 97 次 CMR 检查（83 名移植受者，14 名对照者），以评估整体左心室功能和心肌 T2、T1 和细胞外容积分数（ECV）。根据活检分级，将 CMR 研究分为 4 组：对照组（n=14）、无 ACAR 病史的患者（无 ACAR 病史；n=36）、有 ACAR 病史的患者（ACAR 病史；n=24）和 ACAR+患者（活动期≥1R ACAR；n=23）。
结果
与无 ACAR 患者相比，既往有 ACAR 的患者心肌 T2 明显升高（51.0±3.8 ms 比 49.2 ± 4.0 ms；p=0.02），与对照组相比，无 ACAR 患者心肌 T2 也明显升高（49.2 ± 4.0 ms 比 45.2 ± 2.3 ms；p<0.01）。与无 ACAR 组相比，ACAR+患者的 T2 也升高（52.4±4.7 ms 比 49.2 ± 4.0 ms，p<0.01），但与既往有 ACAR 组相比无差异。相反，无论是否有 ACAR 病史，ACAR+患者的 ECV 均明显高于无 ACAR 的移植受者（无 ACAR：31.5 ± 3.9% 比 26.8 ± 3.3%[p<0.01]；既往有 ACAR：31.5 ± 3.9% 比 26.8 ± 4.0%[p<0.01]）。受试者工作特征曲线分析显示，CMR 年龄、整体 T2 和整体 ECV 的联合模型对 ACAR 具有预测价值（曲线下面积=0.84）。
结论
CMR 衍生的心肌 T2 和 ECV 的联合可能成为 ACAR 的一种非侵入性组织生物标志物。需要在急性 ACAR 期间进行更大规模的研究，以进一步开发用于移植受者监测的多参数 CMR。
Zotero 插件