Miller Robert J H, Thomson Louise, Levine Ryan, Dimbil Sadia J, Patel Jignesh, Kobashigawa Jon A, Kransdorf Evan, Li Debiao, Berman Daniel S, Tamarappoo Balaji
Department of Imaging, Mark Taper Imaging Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Smidt Heart Institute, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Clin Transplant. 2019 Oct;33(10):e13704. doi: 10.1111/ctr.13704. Epub 2019 Sep 25.
Distinct histopathologic changes occur in acute cellular rejection (ACR), antibody-mediated rejection (AMR), and biopsy-negative rejection (BNR). Cardiovascular magnetic resonance (CMR)-based myocardial tissue characterization can be used to quantify these changes. We assessed T1, T2, and extracellular volume fraction (ECV) by CMR in patients with subtypes of rejection. T1, T2, and ECV were quantified at the mid-ventricular level and compared between patients with and without rejection. The association between quantitative tissue characteristics and the combined outcome of death, retransplantation, heart failure hospitalization, or myocardial infarction was evaluated with a Cox-proportional hazards model. In 46 patients, mean age 53.3 ± 13.7 years, 71.7% male, at a median of 7.4 years from transplant, average myocardial T1 was increased in BNR compared with no rejection (1057 vs 1012 msec, P = .006). Average myocardial T2 was elevated in all types of rejection, P < .05. In a cox-proportional hazards model, higher T2 values were associated with an increase in the combined clinical outcome (adjusted HR 1.21, 95% CI 1.06-1.37, P = .004) after adjusting for left ventricular mass index. Myocardial tissue characteristics are abnormal in all subtypes of rejection, and abnormal T2 quantified by CMR provides additional prognostic value.
急性细胞性排斥反应（ACR）、抗体介导的排斥反应（AMR）和活检阴性排斥反应（BNR）会出现不同的组织病理学变化。基于心血管磁共振成像（CMR）的心肌组织特征分析可用于量化这些变化。我们通过CMR评估了不同类型排斥反应患者的T1、T2和细胞外容积分数（ECV）。在心室中部水平对T1、T2和ECV进行量化，并在有排斥反应和无排斥反应的患者之间进行比较。使用Cox比例风险模型评估定量组织特征与死亡、再次移植、心力衰竭住院或心肌梗死综合结局之间的关联。46例患者，平均年龄53.3±13.7岁，男性占71.7%，移植后中位时间为7.4年，与无排斥反应相比，BNR患者的平均心肌T1升高（1057对1012毫秒，P = 0.006）。所有类型的排斥反应中平均心肌T2均升高，P < 0.05。在Cox比例风险模型中，调整左心室质量指数后，较高的T2值与综合临床结局增加相关（校正风险比1.21，95%置信区间1.06 - 1.37，P = 0.004）。所有排斥反应亚型的心肌组织特征均异常，CMR定量的异常T2具有额外的预后价值。
