Vorlat Anne, van Eijk Jeroen, Wiersma Sjoerd, Smid Leroy, Depooter Sofie, Paelinck Bernard, Guerti Khadija, Peeters Bart, Sturkenboom Nicole, Van Craenenbroeck Emeline, Heidbuchel Hein, Van De Heyning Caroline
Department of Cardiology, Antwerp University Hospital, University of Antwerp, Belgium.
Medicine, University of Antwerp, Belgium.
Int J Cardiol Heart Vasc. 2024 Aug 8;54:101479. doi: 10.1016/j.ijcha.2024.101479. eCollection 2024 Oct.
Cardiac fibrosis is increasingly recognized as a marker of worse outcomes in long-term follow-up after heart transplantation (HTX). We investigated the clinical determinants and biomarkers of focal and interstitial cardiac fibrosis as assessed with cardiac magnetic resonance (CMR).
Consecutive HTX recipients underwent CMR with late gadolinium enhancement for focal myocardial fibrosis and T1 mapping for interstitial fibrosis. We calculated the correlations of these findings with clinical parameters, history, biomarkers of fibrosis (B-type natriuretic peptide (BNP), growth differentiation factor-15, galectin-3 and soluble ligand ST2) and echocardiography.
Forty-eight HTX patients were included: median age 63 ± 13 years, 11 ± 6 years after heart transplantation. Only donor weight (p 0.044) and the rate of a > 30 % mismatch between donor and recipient weight (p 0.02) were significantly different in patients with vs. without late LGE. Extracellular volume (ECV) was correlated with the weight mismatch between donor and recipient (r = 0.32, p 0.04), resulting in a higher ECV for oversized donors. BNP was the only biomarker of the four studied that was correlated with interstitial fibrosis as assessed by ECV (r = 0.35, p 0.04). T1 relaxation time was correlated with treated acute cellular rejection grade ≥ 2 (ISHLT grading) (r = 0.34, p 0.02).
Both focal and interstitial fibrosis, as determined by CMR, after heart transplantation are correlated with donor and recipient weight mismatch. BNP was the only biomarker clinically relevant to interstitial cardiac fibrosis.
心脏纤维化日益被认为是心脏移植（HTX）后长期随访中预后较差的一个标志。我们研究了通过心脏磁共振（CMR）评估的局灶性和间质心脏纤维化的临床决定因素和生物标志物。
连续的HTX受者接受CMR检查，采用钆延迟增强评估局灶性心肌纤维化，采用T1 mapping评估间质纤维化。我们计算了这些结果与临床参数、病史、纤维化生物标志物（B型利钠肽（BNP）、生长分化因子-15、半乳糖凝集素-3和可溶性配体ST2）以及超声心动图的相关性。
纳入48例HTX患者：中位年龄63±13岁，心脏移植后11±6年。有或无晚期钆延迟增强（LGE）的患者中，仅供体体重（p = 0.044）以及供体与受体体重>30%不匹配率（p = 0.02）存在显著差异。细胞外容积（ECV）与供体和受体之间的体重不匹配相关（r = 0.32，p = 0.04），导致超大供体的ECV更高。BNP是所研究的四种生物标志物中唯一与通过ECV评估的间质纤维化相关的标志物（r = 0.35，p = 0.04）。T1弛豫时间与治疗后急性细胞排斥反应≥2级（国际心脏和肺移植协会（ISHLT）分级）相关（r = 0.34，p = 0.02）。
心脏移植后通过CMR确定的局灶性和间质纤维化均与供体和受体体重不匹配相关。BNP是唯一与间质心脏纤维化临床相关的生物标志物。
