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Zhuang B, Cui C, He J, Xu J, Wang X, Li L, Jia L, Wu W, Sun X, Li S, Zhou D, Yang W, Wang Y, Zhu L, Sirajuddin A, Zhao S, Lu M. Developing and evaluating a chronic ischemic cardiomyopathy in swine model by rest and stress CMR. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2024; 40:249-260. [PMID: 37971706 DOI: 10.1007/s10554-023-02999-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 10/28/2023] [Indexed: 11/19/2023]
Abstract
A large animal model of chronic coronary artery disease (CAD) is crucial for the understanding the underlying pathophysiological processes of chronic CAD and consequences for cardiac structure and function. The goal of this study was to develop a chronic model of CAD in a swine model and to evaluate the changes of myocardial structure, myocardial motility, and myocardial viability during coronary stenosis. A total of 30 swine (including 24 experimental animals and 6 controls) were enrolled. The chronic ischemia model was constructed by using Ameroid constrictor in experimental group. The 24 experimental animals were further divided into 4 groups (6 animals in each group) and were sacrificed at 1, 2, 3 and 4 weeks after operation for pathological examination, respectively. Cardiac magnetic resonance (CMR) was performed preoperatively and weekly postoperatively until sacrificed both in experimental and control group. CMR cine images, rest/adenosine triphosphate (ATP) stress myocardial contrast perfusion and LGE were performed and analyzed. The rest wall thickening (WT) score was calculated from rest cine images. The MPRI (myocardial perfusion reserve index) and MPR (myocardial perfusion reserve) were calculated based on rest and stress perfusion images. Pathology staining including triphenyltetrazolium chloride, HE and picrosirus red staining were performed after swine were sacrificed and collagen volume fraction (CVF) was calculated. The time to formation of ischemic, hibernating, and infarcted myocardium was recorded. In experimental group, from 1w to 4w after surgery, the rest WT score decreased gradually from 35.2 ± 2.0%, 32.0 ± 2.9% to 30.5 ± 3.0% and finally 29.06 ± 1.78%, p < 0.001. Left ventricular ejection fraction was gradually impaired after modeling (58.9 ± 12.6%, 56.3 ± 10.1%, 55.3 ± 9.0%, 53.8 ± 9.9%, respectively). And the MPR and MPRI also decreased stepwise with extent of surgery time (MPRI dropped from 2.1 ± 0.4, 2.0 ± 0.2 to 1.8 ± 0.3 and finally 1.7 ± 0.1, p = 0.004; MPR dropped from 2.3 ± 0.4, 2.1 ± 0.2 to 1.9 ± 0.4 and finally 1.8 ± 0.1, p < 0.001). Stronger associations between MPR, MPRI and CVF were paralleled lower wall thickening scores in fibrosis-affected areas. The ischemic myocardium was first appeared in the first week after surgery (involving ten segments), hibernated myocardium was first appeared in the second week after surgery (involving seventeen segments). LGE was first appeared in eight swine in the third weeks after surgery (16 segments). At 4w after surgery, average 9.6 g scar tissue was found among 6 swine. At the same time, histological analysis established the presence of fibrosis and ongoing apoptosis in the infarcted area. In conclusion, our study provided valuable insights into the pathophysiological processes of chronic CAD and its consequences for cardiac structure and function in a large animal model through combining myocardial motion and stress perfusion.
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Affiliation(s)
- Baiyan Zhuang
- Department of Radiology, Beijing Anzhen Hospital, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Capital Medical University, Beijing, 100029, People's Republic of China
- Department of Magnetic Resonance Imaging, Cardiovascular imaging and intervention Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Chen Cui
- Department of Magnetic Resonance Imaging, Cardiovascular imaging and intervention Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Jian He
- Department of Magnetic Resonance Imaging, Cardiovascular imaging and intervention Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Jing Xu
- Department of Magnetic Resonance Imaging, Cardiovascular imaging and intervention Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Xin Wang
- Department of Animal Experimental Center, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Li Li
- Department of Pathology, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Liujun Jia
- Department of Animal Experimental Center, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Weichun Wu
- Department of Echocardiography, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaoxin Sun
- Key Laboratory of Cardiovascular Imaging (cultivation), Chinese Academy of Medical Sciences, Beijing, China
| | - Shuang Li
- Department of Magnetic Resonance Imaging, Cardiovascular imaging and intervention Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Di Zhou
- Department of Magnetic Resonance Imaging, Cardiovascular imaging and intervention Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Wenjing Yang
- Department of Magnetic Resonance Imaging, Cardiovascular imaging and intervention Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Yining Wang
- Department of Magnetic Resonance Imaging, Cardiovascular imaging and intervention Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Leyi Zhu
- Department of Magnetic Resonance Imaging, Cardiovascular imaging and intervention Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Arlene Sirajuddin
- National Heart, Lung and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, Maryland, USA
| | - Shihua Zhao
- Department of Magnetic Resonance Imaging, Cardiovascular imaging and intervention Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Minjie Lu
- Department of Magnetic Resonance Imaging, Cardiovascular imaging and intervention Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.
- Key Laboratory of Cardiovascular Imaging (cultivation), Chinese Academy of Medical Sciences, Beijing, China.
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Watanabe K, Arva NC, Robinson JD, Rigsby C, Markl M, Sojka M, Tannous P, Arzu J, Husain N. Cardiac magnetic resonance imaging in detection of progressive graft dysfunction in pediatric heart transplantation. Pediatr Transplant 2024; 28:e14652. [PMID: 38063266 PMCID: PMC10872936 DOI: 10.1111/petr.14652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 11/01/2023] [Accepted: 11/04/2023] [Indexed: 02/07/2024]
Abstract
BACKGROUND Chronic graft failure (CGF) in pediatric heart transplant (PHT) is multifactorial and may present with findings of fibrosis and microvessel disease (MVD) on endomyocardial biopsy (EMB). There is no optimal CGF surveillance method. We evaluated associations between cardiac magnetic resonance imaging (CMR) and historical/EMB correlates of CGF to assess CMR's utility as a surveillance method. METHODS Retrospective analysis of PHT undergoing comprehensive CMR between September 2015 and January 2022 was performed. EMB within 6 months was graded for fibrosis (scale 0-5) and MVD (number of capillaries with stenotic wall thickening per field of view). Correlation analysis and logistic regression were performed. RESULTS Forty-seven PHT with median age at CMR of 15.7 years (11.6, 19.3) and time from transplant of 6.4 years (4.1, 11.0) were studied. Cardiac allograft vasculopathy (CAV) was present in 11/44 (22.0%) and historical rejection in 14/41 (34.2%). CAV was associated with higher global T2 (49.0 vs. 47.0 ms; p = 0.038) and peak T2 (57.0 vs. 53.0 ms; p = 0.013) on CMR. Historical rejection was associated with higher global T2 (49.0 vs. 47.0 ms; p = 0.007) and peak T2 (57.0 vs. 53.0 ms; p = 0.03) as well as global extracellular volume (31.0 vs. 26.3%; p = 0.03). Higher fibrosis score on EMB correlated with smaller indexed left ventricular mass (rho = -0.34; p = 0.019) and greater degree of MVD with lower indexed left ventricular end-diastolic volume (rho = -0.35; p = 0.017). CONCLUSION Adverse ventricular remodeling and abnormal myocardial characteristics on CMR are present in PHT with CAV, historical rejection, as well as greater fibrosis and MVD on EMB. CMR has the potential use for screening of CGF.
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Affiliation(s)
- Kae Watanabe
- Lille Frank Abercrombie Section of Cardiology, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Nicoleta C. Arva
- Department of Pathology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL
| | - Joshua D. Robinson
- Division of Pediatric Cardiology, Ann & Robert H Lurie Children’s Hospital of Chicago, Chicago, IL
| | - Cynthia Rigsby
- Division of Pediatric Radiology, Ann & Robert H Lurie Children’s Hospital of Chicago, Chicago, IL
| | - Michael Markl
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Melanie Sojka
- Division of Pediatric Cardiology, Ann & Robert H Lurie Children’s Hospital of Chicago, Chicago, IL
| | - Paul Tannous
- Division of Pediatric Cardiology, Ann & Robert H Lurie Children’s Hospital of Chicago, Chicago, IL
| | - Jennifer Arzu
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Nazia Husain
- Division of Pediatric Cardiology, Ann & Robert H Lurie Children’s Hospital of Chicago, Chicago, IL
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Pergola V, Cameli M, Mattesi G, Mushtaq S, D’Andrea A, Guaricci AI, Pastore MC, Amato F, Dellino CM, Motta R, Perazzolo Marra M, Dellegrottaglie S, Pedrinelli R, Iliceto S, Nodari S, Perrone Filardi P, Pontone G. Multimodality Imaging in Advanced Heart Failure for Diagnosis, Management and Follow-Up: A Comprehensive Review. J Clin Med 2023; 12:7641. [PMID: 38137711 PMCID: PMC10743799 DOI: 10.3390/jcm12247641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 12/02/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023] Open
Abstract
Advanced heart failure (AHF) presents a complex landscape with challenges spanning diagnosis, management, and patient outcomes. In response, the integration of multimodality imaging techniques has emerged as a pivotal approach. This comprehensive review delves into the profound significance of these imaging strategies within AHF scenarios. Multimodality imaging, encompassing echocardiography, cardiac magnetic resonance imaging (CMR), nuclear imaging and cardiac computed tomography (CCT), stands as a cornerstone in the care of patients with both short- and long-term mechanical support devices. These techniques facilitate precise device selection, placement, and vigilant monitoring, ensuring patient safety and optimal device functionality. In the context of orthotopic cardiac transplant (OTC), the role of multimodality imaging remains indispensable. Echocardiography offers invaluable insights into allograft function and potential complications. Advanced methods, like speckle tracking echocardiography (STE), empower the detection of acute cell rejection. Nuclear imaging, CMR and CCT further enhance diagnostic precision, especially concerning allograft rejection and cardiac allograft vasculopathy. This comprehensive imaging approach goes beyond diagnosis, shaping treatment strategies and risk assessment. By harmonizing diverse imaging modalities, clinicians gain a panoramic understanding of each patient's unique condition, facilitating well-informed decisions. The aim is to highlight the novelty and unique aspects of recently published papers in the field. Thus, this review underscores the irreplaceable role of multimodality imaging in elevating patient outcomes, refining treatment precision, and propelling advancements in the evolving landscape of advanced heart failure management.
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Affiliation(s)
- Valeria Pergola
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Via Giustiniani 2, 35128 Padova, Italy; (G.M.); (F.A.); (M.P.M.); (S.I.)
| | - Matteo Cameli
- Department of Cardiovascular Diseases, University of Sienna, 53100 Siena, Italy; (M.C.); (M.C.P.)
| | - Giulia Mattesi
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Via Giustiniani 2, 35128 Padova, Italy; (G.M.); (F.A.); (M.P.M.); (S.I.)
| | - Saima Mushtaq
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (S.M.); (C.M.D.); (G.P.)
| | | | - Andrea Igoren Guaricci
- University Cardiology Unit, Interdisciplinary Department of Medicine, Policlinic University Hospital, 70121 Bari, Italy;
| | - Maria Concetta Pastore
- Department of Cardiovascular Diseases, University of Sienna, 53100 Siena, Italy; (M.C.); (M.C.P.)
| | - Filippo Amato
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Via Giustiniani 2, 35128 Padova, Italy; (G.M.); (F.A.); (M.P.M.); (S.I.)
| | - Carlo Maria Dellino
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (S.M.); (C.M.D.); (G.P.)
| | - Raffaella Motta
- Unit of Radiology, Department of Medicine, Medical School, University of Padua, 35122 Padua, Italy;
| | - Martina Perazzolo Marra
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Via Giustiniani 2, 35128 Padova, Italy; (G.M.); (F.A.); (M.P.M.); (S.I.)
| | - Santo Dellegrottaglie
- Division of Cardiology, Ospedale Medico-Chirurgico Accreditato Villa dei Fiori, 80011 Acerra, Italy;
| | - Roberto Pedrinelli
- Cardiac, Thoracic and Vascular Department, University of Pisa, 56126 Pisa, Italy;
| | - Sabino Iliceto
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Via Giustiniani 2, 35128 Padova, Italy; (G.M.); (F.A.); (M.P.M.); (S.I.)
| | - Savina Nodari
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Institute of Cardiology, University of Brescia, 25123 Brescia, Italy;
| | - Pasquale Perrone Filardi
- Department of Advanced Biomedical Sciences, Federico II University of Naples, 80138 Naples, Italy;
| | - Gianluca Pontone
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (S.M.); (C.M.D.); (G.P.)
- Department of Biomedical, Surgical and Sciences, University of Milan, 20122 Milan, Italy
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Wu MY, Ali Khawaja RD, Vargas D. Heart Transplantation: Indications, Surgical Techniques, and Complications. Radiol Clin North Am 2023; 61:847-859. [PMID: 37495292 DOI: 10.1016/j.rcl.2023.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
Heart transplantation has been increasingly performed for patients with end-stage heart failure most commonly related to ischemic and non-ischemic cardiomyopathies. The major complications are procedure-related complications, infection, acute rejection, cardiac allograft vasculopathy, and malignancy. Radiologists have an important role in the evaluation of transplant candidates and early detection of postoperative complications.
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Affiliation(s)
- Markus Y Wu
- Department of Radiology, University of Colorado, 12401 East 17th Avenue, Aurora, CO 80045, USA.
| | - Ranish Deedar Ali Khawaja
- Department of Radiology, University of Colorado, 12401 East 17th Avenue, Aurora, CO 80045, USA. https://twitter.com/RanishKhawaja
| | - Daniel Vargas
- Department of Radiology, University of Colorado, 12401 East 17th Avenue, Aurora, CO 80045, USA. https://twitter.com/DanielVargasMD
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Ahn Y, Koo HJ, Hyun J, Lee SE, Jung SH, Park DW, Ahn JM, Kang DY, Park SJ, Hwang HS, Kang JW, Yang DH, Kim JJ. CT Coronary Angiography and Dynamic CT Myocardial Perfusion for Detection of Cardiac Allograft Vasculopathy. JACC Cardiovasc Imaging 2023; 16:934-947. [PMID: 37407125 DOI: 10.1016/j.jcmg.2022.12.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 12/23/2022] [Indexed: 07/07/2023]
Abstract
BACKGROUND Cardiac allograft vasculopathy (CAV) is a major obstacle limiting long-term graft survival. Effective noninvasive surveillance modalities reflecting both coronary artery and microvascular components of CAV are needed. OBJECTIVES The authors evaluated the diagnostic performance of dynamic computed tomography-myocardial perfusion imaging (CT-MPI) and coronary computed tomography angiography (CCTA) for CAV. METHODS A total of 63 heart transplantation patients underwent combined CT-MPI and CCTA plus invasive coronary angiography (ICA) with intravascular ultrasonography (IVUS) between December 2018 and October 2021. The median interval between CT-MPI and heart transplantation was 4.3 years. Peak myocardial blood flow (MBF) of the whole myocardium (MBFglobal) and minimum MBF (MBFmin) among the 16 segments according to the American Heart Association model, except the left ventricular apex, were calculated from CT-MPI. CCTA was assessed qualitatively, and the degree of coronary artery stenosis was recorded. CAV was diagnosed based on both ICA (ISHLT criteria) and IVUS. Patients were followed up for a median time of 2.3 years after CT-MPI and a median time of 5.7 years after transplantation. RESULTS Among the 63 recipients, 35 (55.6%) had diagnoses of CAV. The median MBFglobal and MBFmin were significantly lower in patients with CAV (128.7 vs 150.4 mL/100 mL/min; P = 0.014; and 96.9 vs 122.8 mL/100 mL/min; P < 0.001, respectively). The combined use of coronary artery stenosis on CCTA and MBFmin showed the highest diagnostic performance with an area under the curve of 0.886 (sensitivity: 74.3%, specificity: 96.4%, positive predictive value: 96.3%, and negative predictive value: 75.0%). CONCLUSIONS The combination of CT-MPI and CCTA demonstrated excellent diagnostic performance for the detection of CAV. One-stop evaluation of the coronary artery and microvascular components involved in CAV using combined CCTA and CT-MPI may be a potent noninvasive screening method for early detection of CAV.
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Affiliation(s)
- Yura Ahn
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Hyun Jung Koo
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
| | - Junho Hyun
- Division of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Sang Eun Lee
- Division of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Sung Ho Jung
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Duk-Woo Park
- Division of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jung-Min Ahn
- Division of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Do-Yoon Kang
- Division of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Seung-Jung Park
- Division of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Hee Sang Hwang
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Joon-Won Kang
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Dong Hyun Yang
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jae-Joong Kim
- Division of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Napolitano C, Grutter G, Francalanci P, Amodeo A, Secinaro A. Case report: Coronary allograft vasculopathy: an accurate reflection of the histopathological findings on cardiovascular magnetic resonance imaging. Front Cardiovasc Med 2023; 10:1123212. [PMID: 37265562 PMCID: PMC10229782 DOI: 10.3389/fcvm.2023.1123212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 04/24/2023] [Indexed: 06/03/2023] Open
Abstract
Heart transplant recipients undergo extensive invasive and non-invasive postoperative screening to exclude complications, such as allograft rejection and vasculopathy. Cardiac magnetic resonance imaging is a non-invasive, non-irradiating, diagnostic tool for monitoring graft health and identifying possible tissue rejection or myocardial fibrosis. We describe the case of a 29-year-old female heart transplant recipient admitted to our care center with a worsening clinical condition. The patient underwent clinical evaluation, blood tests, including troponin I and N-terminal pro brain type natriuretic peptide, transthoracic echocardiography, invasive coronary angiography, and cardiovascular magnetic resonance imaging. Cardiovascular magnetic resonance imaging showed widespread sub-epicardial hyperintensity of the myocardial segments along the course of the coronary arteries. T2 mapping sequences showed an elevated value and the myocardial native T1 values and extracellular volume percentage were significantly increased. Late gadolinium enhancement demonstrated a diffuse sub-epicardial hypersignal along the lateral, free, and left ventricular walls. All the sequences evidenced widespread hyper-enhancement of epicardial fat along the course of the thickened main coronary artery walls. One month later, the recipient underwent re-transplantation due to progressive worsening of the clinical condition and refractoriness to intravenous medication. The anatomopathological findings of the explanted heart provided impressive visualization of structural and histopathological changes. These results could guide the tailoring of preventive therapeutic strategies and non-invasive monitoring of cardiac grafts.
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Affiliation(s)
- Carmela Napolitano
- Advanced Cardiovascular Imaging Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Giorgia Grutter
- Heart Failure, Transplantation and Cardio-Respiratory Mechanical Assistance Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Paola Francalanci
- Pathological Anatomy Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Antonio Amodeo
- Heart Failure, Transplantation and Cardio-Respiratory Mechanical Assistance Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Aurelio Secinaro
- Advanced Cardiovascular Imaging Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
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7
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Estep JD, Disla JP. The Potential Role of CT Coronary Angiography and Dynamic CT MPI to Detect Early Cardiac Allograft Vasculopathy. JACC Cardiovasc Imaging 2023:S1936-878X(23)00183-3. [PMID: 37227334 DOI: 10.1016/j.jcmg.2023.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 03/30/2023] [Indexed: 05/26/2023]
Affiliation(s)
- Jerry D Estep
- Robert and Suzanne Tomsich Department of Cardiology, Section of Heart Failure and Cardiac Transplant Medicine and Section of General Cardiology and Imaging, Cleveland Clinic Florida, Weston, Florida, USA.
| | - Jenny P Disla
- Robert and Suzanne Tomsich Department of Cardiology, Section of Heart Failure and Cardiac Transplant Medicine and Section of General Cardiology and Imaging, Cleveland Clinic Florida, Weston, Florida, USA
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8
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Watanabe K, Husain N, Arzu JL, Wechsler JB, Arva NC. Increased fibrosis and microvessel disease in allograft endomyocardial biopsies of children with chronic graft failure due to cardiac allograft vasculopathy. Cardiovasc Pathol 2023; 63:107509. [PMID: 36442702 DOI: 10.1016/j.carpath.2022.107509] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 11/11/2022] [Accepted: 11/21/2022] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Chronic graft failure (CGF) is the leading cause of mortality in pediatric heart transplant (PHT) patients and has multifactorial pathogenesis including cardiac allograft vasculopathy (CAV). CGF can present with microvessel disease (MVD) and myocardial fibrosis on endomyocardial biopsies (EMB). We investigated if CGF due to moderate- severe (M-S) CAV has histopathologic MVD and fibrosis prior to or at the time of CAV diagnosis. METHOD This retrospective case-control study included PHT with CGF secondary to M-S CAV. Control patients had no CAV or CGF. EMBs from CAV (3 sets: at 1-year post-transplant 1yrCAV, pre-CAV, and at the time of CAV diagnosis) and non-CAV cohorts were reviewed to grade the fibrosis and quantify MVD. Histopathologic changes were correlated and compared between CAV/non-CAV groups. RESULTS Each group had 8 patients. The median age at transplantation and time since transplant were similar between the two groups (P=.71 and P=.91, respectively). Fibrosis grade was 3.0 for CAV cohort compared to 1.0 for control (P= .003) and MVD score was 2.1 in CAV and 0.5 in non-CAV patients (P=.003). Similar degrees of fibrosis and MVD were present even before any evidence of CAV (1yrCAV fibrosis grade 2.5, pre-CAV fibrosis grade 2; 1yrCAV vs CAV P=.75, pre-CAV vs CAV P=.63; 1yrCAV MVD score 2, pre-CAV MVD score 2; 1yrCAV vs CAV P=1, pre-CAV vs CAV P=.91). The degree of MVD correlated with fibrosis (r=0.63, P<.0001) for all EMBs. CONCLUSION Simultaneous myocardial fibrosis and MVD are noted in CGF secondary to M-S CAV, changes that occur before angiographic CAV. EMBs can reveal significant changes in patients with subsequent development of CAV and may be used to modify the follow-up and treatment for these high-risk patients.
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Affiliation(s)
- Kae Watanabe
- Division of Cardiology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Nazia Husain
- Division of Cardiology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jennifer L Arzu
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Joshua B Wechsler
- Division of Gastroenterology, Hepatology & Nutrition, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Nicoleta C Arva
- Department of Pathology, Ann & Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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Velleca A, Shullo MA, Dhital K, Azeka E, Colvin M, DePasquale E, Farrero M, García-Guereta L, Jamero G, Khush K, Lavee J, Pouch S, Patel J, Michaud CJ, Shullo M, Schubert S, Angelini A, Carlos L, Mirabet S, Patel J, Pham M, Urschel S, Kim KH, Miyamoto S, Chih S, Daly K, Grossi P, Jennings D, Kim IC, Lim HS, Miller T, Potena L, Velleca A, Eisen H, Bellumkonda L, Danziger-Isakov L, Dobbels F, Harkess M, Kim D, Lyster H, Peled Y, Reinhardt Z. The International Society for Heart and Lung Transplantation (ISHLT) Guidelines for the Care of Heart Transplant Recipients. J Heart Lung Transplant 2022; 42:e1-e141. [PMID: 37080658 DOI: 10.1016/j.healun.2022.10.015] [Citation(s) in RCA: 117] [Impact Index Per Article: 58.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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10
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Velleca A, Shullo MA, Dhital K, Azeka E, Colvin M, DePasquale E, Farrero M, García-Guereta L, Jamero G, Khush K, Lavee J, Pouch S, Patel J, Michaud CJ, Shullo M, Schubert S, Angelini A, Carlos L, Mirabet S, Patel J, Pham M, Urschel S, Kim KH, Miyamoto S, Chih S, Daly K, Grossi P, Jennings D, Kim IC, Lim HS, Miller T, Potena L, Velleca A, Eisen H, Bellumkonda L, Danziger-Isakov L, Dobbels F, Harkess M, Kim D, Lyster H, Peled Y, Reinhardt Z. The International Society for Heart and Lung Transplantation (ISHLT) Guidelines for the Care of Heart Transplant Recipients. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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11
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Clark DE, Aggarwal SK, Phillips NJ, Soslow JH, Dendy JM, Hughes SG. Cardiac Magnetic Resonance in the Evaluation of COVID-19. Card Fail Rev 2022; 8:e09. [PMID: 35399549 PMCID: PMC8978025 DOI: 10.15420/cfr.2021.20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 10/26/2021] [Indexed: 12/15/2022] Open
Abstract
Cardiovascular involvement following COVID-19 is heterogeneous, prevalent and is often missed by echocardiography and serum biomarkers (such as troponin I and brain natriuretic peptide). Cardiac magnetic resonance (CMR) is the gold standard non-invasive imaging modality to phenotype unique populations after COVID-19, such as competitive athletes with a heightened risk of sudden cardiac death, patients with multisystem inflammatory syndrome, and people suspected of having COVID-19 vaccine-induced myocarditis. This review summarises the key attributes of CMR, reviews the literature that has emerged for using CMR for people who may have COVID-19-related complications after COVID-19, and offers expert opinion regarding future avenues of investigation and the importance of reporting findings.
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Affiliation(s)
- Daniel E Clark
- Division of Cardiovascular Medicine, Department of Internal Medicine, Vanderbilt University Medical Centre, Nashville, TN, US
| | - Sachin K Aggarwal
- Vanderbilt School of Medicine, Vanderbilt University, Nashville, TN, US
| | - Neil J Phillips
- Department of Internal Medicine, Vanderbilt University Medical Centre, Nashville, TN, US
| | - Jonathan H Soslow
- Thomas P Graham Division of Paediatric Cardiology, Department of Paediatrics, Monroe Carell Jr Children’s Hospital at Vanderbilt, Nashville, TN, US
| | - Jeffrey M Dendy
- Division of Cardiovascular Medicine, Department of Internal Medicine, Vanderbilt University Medical Centre, Nashville, TN, US
| | - Sean G Hughes
- Division of Cardiovascular Medicine, Department of Internal Medicine, Vanderbilt University Medical Centre, Nashville, TN, US
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12
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Non-Invasive Imaging in the Evaluation of Cardiac Allograft Vasculopathy in Heart Transplantation: A Systematic Review. Curr Probl Cardiol 2022; 47:101103. [PMID: 35016989 DOI: 10.1016/j.cpcardiol.2022.101103] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 01/03/2022] [Indexed: 11/22/2022]
Abstract
Cardiac allograft vasculopathy (CAV) is the leading cause of long-term graft dysfunction in patients with heart transplantation and is linked with significant morbidity and mortality. Currently, the gold standard for diagnosing CAV is coronary imaging with intravascular ultrasound (IVUS) during traditional invasive coronary angiography (ICA). Invasive imaging, however, carries increased procedural risk and expense to patients in addition to requiring an experienced interventionalist. With the improvements in non-invasive cardiac imaging modalities such as transthoracic echocardiography (TTE), computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET), an alternative non-invasive imaging approach for the early detection of CAV may be feasible. In this systematic review, we explored the literature to investigate the utility of non-invasive imaging in diagnosis of CAV in >3000 patients across 49 studies. We also discuss the strengths and weaknesses for each imaging modality. Overall, all four imaging modalities show good to excellent accuracy for identifying CAV with significant variations across studies. Majority of the studies compared non-invasive imaging with ICA without intravascular imaging. In summary, non-invasive imaging modalities offer an alternative approach to invasive coronary imaging for CAV. Future studies should investigate longitudinal non-invasive protocols in low-risk patients after heart transplantation.
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13
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Abbasi MA, Blake AM, Sarnari R, Lee D, Anderson AS, Ghafourian K, Khan SS, Vorovich EE, Rich JD, Wilcox JE, Yancy CW, Carr JC, Markl M. Multiparametric Cardiac Magnetic Resonance Imaging Detects Altered Myocardial Tissue and Function in Heart Transplantation Recipients Monitored for Cardiac Allograft Vasculopathy. J Cardiovasc Imaging 2022; 30:263-275. [PMID: 36280267 PMCID: PMC9592247 DOI: 10.4250/jcvi.2022.0003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 04/26/2022] [Accepted: 05/02/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Cardiac allograft vasculopathy (CAV) is a complication beyond the first-year post-heart transplantation (HTx). We aimed to test the utility of cardiac magnetic resonance (CMR) to detect functional/structural changes in HTx recipients with CAV. METHODS Seventy-seven prospectively recruited HTx recipients beyond the first-year post-HTx and 18 healthy controls underwent CMR, including cine imaging of ventricular function and T1- and T2-mapping to assess myocardial tissue changes. Data analysis included quantification of global cardiac function and regional T2, T1 and extracellular volume based on the 16-segment model. International Society for Heart and Lung Transplantation criteria was used to adjudicate CAV grade (0–3) based on coronary angiography. RESULTS The majority of HTx recipients (73%) presented with CAV (1: n = 42, 2/3: n = 14, 0: n = 21). Global and segmental T2 (49.5 ± 3.4 ms vs 50.6 ± 3.4 ms, p < 0.001;16/16 segments) were significantly elevated in CAV-0 compared to controls. When comparing CAV-2/3 to CAV-1, global and segmental T2 were significantly increased (53.6 ± 3.2 ms vs. 50.6 ± 2.9 ms, p < 0.001; 16/16 segments) and left ventricular ejection fraction was significantly decreased (54 ± 9% vs. 59 ± 9%, p < 0.05). No global, structural, or functional differences were seen between CAV-0 and CAV-1. CONCLUSIONS Transplanted hearts display functional and structural alteration compared to native hearts, even in those without evidence of macrovasculopathy (CAV-0). In addition, CMR tissue parameters were sensitive to changes in CAV-1 vs. 2/3 (mild vs. moderate/severe). Further studies are warranted to evaluate the diagnostic value of CMR for the detection and classification of CAV.
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Affiliation(s)
- Muhannad A. Abbasi
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Allison M. Blake
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Roberto Sarnari
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Daniel Lee
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Allen S. Anderson
- Division of Cardiology, Department of Medicine, Northwestern University, Chicago, IL, USA
| | - Kambiz Ghafourian
- Division of Cardiology, Department of Medicine, Northwestern University, Chicago, IL, USA
| | - Sadiya S. Khan
- Division of Cardiology, Department of Medicine, Northwestern University, Chicago, IL, USA
| | - Esther E. Vorovich
- Division of Cardiology, Department of Medicine, Northwestern University, Chicago, IL, USA
| | - Jonathan D. Rich
- Division of Cardiology, Department of Medicine, Northwestern University, Chicago, IL, USA
| | - Jane E. Wilcox
- Division of Cardiology, Department of Medicine, Northwestern University, Chicago, IL, USA
| | - Clyde W. Yancy
- Division of Cardiology, Department of Medicine, Northwestern University, Chicago, IL, USA
| | - James C. Carr
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Michael Markl
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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14
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Feher A, Sinusas AJ. Evaluation of cardiac allograft vasculopathy by positron emission tomography. J Nucl Cardiol 2021; 28:2616-2628. [PMID: 33389637 DOI: 10.1007/s12350-020-02438-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 11/04/2020] [Indexed: 12/22/2022]
Abstract
Cardiac allograft vasculopathy (CAV) remains one of the most important late occurring complications in heart transplant (HT) recipients significantly effecting graft survival. Recently, there has been tremendous focus on the development of effective and safe non-invasive diagnostic strategies for the diagnosis of CAV employing a wide range of imaging technologies. During the past decade multiple studies have been published using positron emission tomography (PET) myocardial perfusion imaging, establishing the value of PET myocardial blood flow quantification for the evaluation of CAV. These independent investigations demonstrate that PET can be successfully used to establish the diagnosis of CAV, can be utilized for prognostication and may be used for serial monitoring of HT recipients. In addition, molecular imaging techniques have started to emerge as new tools to enhance our knowledge to better understand the pathophysiology of CAV.
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Affiliation(s)
- Attila Feher
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, P.O. Box 208017, Dana 3, New Haven, CT, 06520, USA.
| | - Albert J Sinusas
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, P.O. Box 208017, Dana 3, New Haven, CT, 06520, USA
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA
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15
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Husain N, Watanabe K, Berhane H, Gupta A, Markl M, Rigsby CK, Robinson JD. Multi-parametric cardiovascular magnetic resonance with regadenoson stress perfusion is safe following pediatric heart transplantation and identifies history of rejection and cardiac allograft vasculopathy. J Cardiovasc Magn Reson 2021; 23:135. [PMID: 34809650 PMCID: PMC8607604 DOI: 10.1186/s12968-021-00803-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 08/10/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The progressive risk of graft failure in pediatric heart transplantation (PHT) necessitates close surveillance for rejection and coronary allograft vasculopathy (CAV). The current gold standard of surveillance via invasive coronary angiography is costly, imperfect and associated with complications. Our goal was to assess the safety and feasibility of a comprehensive multi-parametric CMR protocol with regadenoson stress perfusion in PHT and evaluate for associations with clinical history of rejection and CAV. METHODS We performed a retrospective review of 26 PHT recipients who underwent stress CMR with tissue characterization and compared with 18 age-matched healthy controls. CMR protocol included myocardial T2, T1 and extracellular volume (ECV) mapping, late gadolinium enhancement (LGE), qualitative and semi-quantitative stress perfusion (myocardial perfusion reserve index; MPRI) and strain imaging. Clinical, demographics, rejection score and CAV history were recorded and correlated with CMR parameters. RESULTS Mean age at transplant was 9.3 ± 5.5 years and median duration since transplant was 5.1 years (IQR 7.5 years). One patient had active rejection at the time of CMR, 11/26 (42%) had CAV 1 and 1/26 (4%) had CAV 2. Biventricular volumes were smaller and cardiac output higher in PHT vs. healthy controls. Global T1 (1053 ± 42 ms vs 986 ± 42 ms; p < 0.001) and ECV (26.5 ± 4.0% vs 24.0 ± 2.7%; p = 0.017) were higher in PHT compared to helathy controls. Significant relationships between changes in myocardial tissue structure and function were noted in PHT: increased T2 correlated with reduced LVEF (r = - 0.57, p = 0.005), reduced global circumferential strain (r = - 0.73, p < 0.001) and reduced global longitudinal strain (r = - 0.49, p = 0.03). In addition, significant relationships were noted between higher rejection score and global T1 (r = 0.38, p = 0.05), T2 (r = 0.39, p = 0.058) and ECV (r = 0.68, p < 0.001). The presence of even low-grade CAV was associated with higher global T1, global ECV and maximum segmental T2. No major side effects were noted with stress testing. MPRI was analyzed with good interobserver reliability and was lower in PHT compared to healthy controls (0.69 ± - 0.21 vs 0.94 ± 0.22; p < 0.001). CONCLUSION In a PHT population with low incidence of rejection or high-grade CAV, CMR demonstrates important differences in myocardial structure, function and perfusion compared to age-matched healthy controls. Regadenoson stress perfusion CMR could be safely and reliably performed. Increasing T2 values were associated with worsening left ventricular function and increasing T1/ECV values were associated with rejection history and low-grade CAV. These findings warrant larger prospective studies to further define the role of CMR in PHT graft surveillance.
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Affiliation(s)
- Nazia Husain
- Department of Cardiology, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, USA
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Kae Watanabe
- Department of Cardiology, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, USA
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Haben Berhane
- Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Chicago, USA
| | - Aditi Gupta
- Lincoln Medical and Mental Health Center, Bronx, NY USA
| | - Michael Markl
- Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Chicago, USA
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Cynthia K. Rigsby
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, USA
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, USA
- Department of Medical Imaging, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, USA
| | - Joshua D. Robinson
- Department of Cardiology, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, USA
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, USA
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, USA
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16
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Pober JS, Chih S, Kobashigawa J, Madsen JC, Tellides G. Cardiac allograft vasculopathy: current review and future research directions. Cardiovasc Res 2021; 117:2624-2638. [PMID: 34343276 PMCID: PMC8783389 DOI: 10.1093/cvr/cvab259] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 07/02/2021] [Accepted: 07/29/2021] [Indexed: 12/25/2022] Open
Abstract
Cardiac allograft vasculopathy (CAV) is a pathologic immune-mediated remodelling of the vasculature in transplanted hearts and, by impairing perfusion, is the major cause of late graft loss. Although best understood following cardiac transplantation, similar forms of allograft vasculopathy occur in other vascularized organ grafts and some features of CAV may be shared with other immune-mediated vasculopathies. Here, we describe the incidence and diagnosis, the nature of the vascular remodelling, immune and non-immune contributions to pathogenesis, current therapies, and future areas of research in CAV.
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MESH Headings
- Adaptive Immunity
- Animals
- Coronary Artery Disease/epidemiology
- Coronary Artery Disease/immunology
- Coronary Artery Disease/metabolism
- Coronary Artery Disease/pathology
- Coronary Vessels/immunology
- Coronary Vessels/metabolism
- Coronary Vessels/pathology
- Endothelial Cells/immunology
- Endothelial Cells/metabolism
- Endothelial Cells/pathology
- Graft Rejection/epidemiology
- Graft Rejection/immunology
- Graft Rejection/metabolism
- Graft Rejection/pathology
- Graft Survival
- Heart Transplantation/adverse effects
- Humans
- Immunity, Innate
- Muscle, Smooth, Vascular/immunology
- Muscle, Smooth, Vascular/metabolism
- Muscle, Smooth, Vascular/pathology
- Myocytes, Smooth Muscle/immunology
- Myocytes, Smooth Muscle/metabolism
- Myocytes, Smooth Muscle/pathology
- Risk Factors
- Signal Transduction
- Treatment Outcome
- Vascular Remodeling
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Affiliation(s)
- Jordan S Pober
- Department of Immunobiology, Pathology and Dermatology, Yale School of Medicine, 10 Amistad Street, New Haven CT 06520-8089, USA
| | - Sharon Chih
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Jon Kobashigawa
- Department of Medicine, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, USA
| | - Joren C Madsen
- Division of Cardiac Surgery and Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - George Tellides
- Department of Surgery (Cardiac Surgery), Yale School of Medicine, New Haven, CT, USA
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17
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Sciaccaluga C, Ghionzoli N, Mandoli GE, Sisti N, D'Ascenzi F, Focardi M, Bernazzali S, Vergaro G, Emdin M, Valente S, Cameli M. The role of non-invasive imaging modalities in cardiac allograft vasculopathy: an updated focus on current evidences. Heart Fail Rev 2021; 27:1235-1246. [PMID: 34383194 PMCID: PMC9197817 DOI: 10.1007/s10741-021-10155-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/27/2021] [Indexed: 11/24/2022]
Abstract
Cardiac allograft vasculopathy (CAV) is an obliterative and diffuse form of vasculopathy affecting almost 50% of patients after 10 years from heart transplant and represents the most common cause of long-term cardiovascular mortality among heart transplant recipients. The gold standard diagnostic technique is still invasive coronary angiography, which however holds potential for complications, especially contrast-related kidney injury and procedure-related vascular lesions. Non-invasive and contrast-sparing imaging techniques have been advocated and investigated over the past decades, in order to identify those that could replace coronary angiography or at least reach comparable accuracy in CAV detection. In addition, they could help the clinician in defining optimal timing for invasive testing. This review attempts to examine the currently available non-invasive imaging techniques that may be used in the follow-up of heart transplant patients, spanning from echocardiography to nuclear imaging, cardiac magnetic resonance and cardiac computed tomography angiography, weighting their advantages and disadvantages.
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Affiliation(s)
- C Sciaccaluga
- Department of Medical Biotechnologies, Section of Cardiology, University of Siena, Siena, Italy.
| | - N Ghionzoli
- Department of Medical Biotechnologies, Section of Cardiology, University of Siena, Siena, Italy
| | - G E Mandoli
- Department of Medical Biotechnologies, Section of Cardiology, University of Siena, Siena, Italy
| | - N Sisti
- Department of Medical Biotechnologies, Section of Cardiology, University of Siena, Siena, Italy
| | - F D'Ascenzi
- Department of Medical Biotechnologies, Section of Cardiology, University of Siena, Siena, Italy
| | - M Focardi
- Department of Medical Biotechnologies, Section of Cardiology, University of Siena, Siena, Italy
| | - S Bernazzali
- Department of Cardiac Surgery, University Hospital of Siena, Siena, Italy
| | - G Vergaro
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy.,Division of Cardiology and Cardiovascular Medicine, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - M Emdin
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy.,Division of Cardiology and Cardiovascular Medicine, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - S Valente
- Department of Medical Biotechnologies, Section of Cardiology, University of Siena, Siena, Italy
| | - M Cameli
- Department of Medical Biotechnologies, Section of Cardiology, University of Siena, Siena, Italy
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18
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Duran SR, Huffaker T, Dixon B, Gooty V, Abou Zahr R, Arar Y, Greer JS, Butts RJ, Hussain MT. Feasibility and safety of quantitative adenosine stress perfusion cardiac magnetic resonance imaging in pediatric heart transplant patients with and without coronary allograft vasculopathy. Pediatr Radiol 2021; 51:1311-1321. [PMID: 33791838 DOI: 10.1007/s00247-021-04977-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 11/11/2020] [Accepted: 01/21/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Pediatric heart transplant patients require cardiac catheterization to monitor for coronary allograft vasculopathy. Cardiac catheterization has no safe and consistent method for measuring microvascular disease. Stress perfusion cardiac magnetic resonance imaging (MRI) assessing microvascular disease has been performed in adults. OBJECTIVE To investigate the feasibility and safety of performing cardiac MRI with quantitative adenosine stress perfusion testing in pediatric heart transplant patients with and without coronary allograft vasculopathy. MATERIALS AND METHODS All pediatric heart transplant patients with coronary vasculopathy at our institution were asked to participate. Age- and gender-matched pediatric heart transplant patients without vasculopathy were recruited for comparison. Patients underwent cardiac MRI with adenosine stress perfusion testing. RESULTS Sixteen pediatric heart transplant patients, ages 6-22 years, underwent testing. Nine patients had vasculopathy by angiography. No heart block or other complications occurred during the study. The myocardial perfusion reserve for patients with vasculopathy showed no significant difference with comparison patients (median: 1.43 vs. 1.48; P=0.49). Values for both groups were lower than expected values based on previous adult studies. The patients were also analyzed for time after transplant and the number of rejection episodes. Patients within 6 years of transplantation had a nonsignificant trend toward a higher myocardial perfusion reserve (median: 1.57) versus patients with older transplants (median: 1.47; P=0.46). Intra- and interobserver reproducibility were 97% and 92%, respectively. CONCLUSION Myocardial perfusion reserve is a safe and feasible method for estimating myocardial perfusion in pediatric heart transplant patients. There is no reliable way to monitor microvascular disease in pediatric patients. This method shows potential and deserves investigation in a larger cohort.
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Affiliation(s)
- Silvestre R Duran
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA. .,Division of Pediatric Cardiology, Children's Medical Center Dallas, Dallas, TX, USA. .,Division of Pediatric Cardiology, University Hospitals Rainbow Babies & Children's Hospital, Cleveland, OH, USA.
| | - Tyler Huffaker
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA
| | - Bryant Dixon
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA
| | - Vasu Gooty
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA.,Division of Pediatric Cardiology, Children's Medical Center Dallas, Dallas, TX, USA
| | - Riad Abou Zahr
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA.,Division of Pediatric Cardiology, Children's Medical Center Dallas, Dallas, TX, USA
| | - Yousef Arar
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA.,Division of Pediatric Cardiology, Children's Medical Center Dallas, Dallas, TX, USA
| | - Joshua S Greer
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA
| | - Ryan J Butts
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA.,Division of Pediatric Cardiology, Children's Medical Center Dallas, Dallas, TX, USA
| | - Mohammad T Hussain
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA.,Division of Pediatric Cardiology, Children's Medical Center Dallas, Dallas, TX, USA
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19
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Abstract
Heart transplantation (HTx) remains the optimal treatment for selected patients with end-stage advanced heart failure. However, survival is limited early by acute rejection and long term by cardiac allograft vasculopathy (CAV). Even though the diagnosis of rejection is based on histology, cardiac imaging provides a pivotal role for early detection and severity assessment of these hazards. The present review focuses on the use and reliability of different invasive and non-invasive imaging modalities to detect and monitor CAV and rejection after HTx. Coronary angiography remains the corner stone in routine CAV surveillance. However, angiograms are invasive and underestimates the CAV severity especially in the early phase. Intravascular ultrasound and optical coherence tomography are invasive methods for intracoronary imaging that detects early CAV lesions not evident by angiograms. Non-invasive imaging can be divided into myocardial perfusion imaging, anatomical/structural imaging and myocardial functional imaging. The different non-invasive imaging modalities all provide clinical and prognostic information and may have a gatekeeper role for invasive monitoring. Acute rejection and CAV are still significant clinical problems after HTx. No imaging modality provides complete information on graft function, coronary anatomy and myocardial perfusion. However, a combination of invasive and non-invasive modalities at different stages following HTx should be considered for optimal personalized surveillance and risk stratification.
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Affiliation(s)
| | | | - Hans Eiskjær
- Department of Cardiology, Aarhus University Hospital, Denmark
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20
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Sciaccaluga C, Mandoli GE, Sisti N, Natali MB, Ibrahim A, Menci D, D'Errico A, Donati G, Benfari G, Valente S, Bernazzali S, Maccherini M, Mondillo S, Cameli M, Focardi M. Detection of cardiac allograft vasculopathy by multi-layer left ventricular longitudinal strain in heart transplant recipients. Int J Cardiovasc Imaging 2021; 37:1621-1628. [PMID: 33442856 DOI: 10.1007/s10554-020-02147-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 12/24/2020] [Indexed: 11/30/2022]
Abstract
Cardiac allograft vasculopathy (CAV) is an obliterative and diffuse type of coronaropathy that develops in the transplanted human heart, representing a major cause of graft failure and mortality. Nowadays the gold standard for the diagnosis of CAV is coronary angiography (CA). Non-invasive CAV detection, especially in the early stages of the disease, is still challenging. Our study aimed to investigate the role of speckle tracking echocardiography (STE), in particular three-layer STE, in predicting CAV at early stages, and if other traditional echocardiographic, clinical or biochemical parameters could relate to CAV. The study population was composed of a total of 33 heart transplanted patients, divided accordingly to the presence or absence of CAV (12 CAV+ , 22 CAV-). All subjects underwent a complete transthoracic echocardiographic examination on the same day of the CA, and all conventional parameters of myocardial function were obtained, including strain values assessed by STE. Strain values were significantly reduced in presence of CAV, at each myocardial layer but in particular the endocardial-epicardial gradient (- 4.15 ± 1.6 vs - 1.7 ± 0.4% < .0001) that was also highly predictive of CAV (AUC at ROC curve 0.97). Among diastolic parameters, the E wave deceleration time (DT) and the mean E/e' ratio were strongly positively associated with CAV. In our population, left ventricular global longitudinal strain (GLS), layer-specific GLS and the endocardial-epicardial LS gradient, E wave DT and E/e' ratio were the best independent non-invasive predictors of CAV.
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Affiliation(s)
- C Sciaccaluga
- Department of Medical Biotechnologies, Section of Cardiology, University of Siena, Siena, Italy.
| | - G E Mandoli
- Department of Medical Biotechnologies, Section of Cardiology, University of Siena, Siena, Italy
| | - N Sisti
- Department of Medical Biotechnologies, Section of Cardiology, University of Siena, Siena, Italy
| | - M B Natali
- Department of Medical Biotechnologies, Section of Cardiology, University of Siena, Siena, Italy
| | - A Ibrahim
- Department of Medical Biotechnologies, Section of Cardiology, University of Siena, Siena, Italy
| | - D Menci
- Department of Medical Biotechnologies, Section of Cardiology, University of Siena, Siena, Italy
| | - A D'Errico
- Department of Internal Medicine, University of Siena, Siena, Italy
| | - G Donati
- Department of Internal Medicine, University of Siena, Siena, Italy
| | - G Benfari
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - S Valente
- Department of Medical Biotechnologies, Section of Cardiology, University of Siena, Siena, Italy
| | - S Bernazzali
- Department of Cardiac Surgery, University Hospital of Siena, Siena, Italy
| | - M Maccherini
- Department of Cardiac Surgery, University Hospital of Siena, Siena, Italy
| | - S Mondillo
- Department of Medical Biotechnologies, Section of Cardiology, University of Siena, Siena, Italy
| | - M Cameli
- Department of Medical Biotechnologies, Section of Cardiology, University of Siena, Siena, Italy
| | - M Focardi
- Department of Medical Biotechnologies, Section of Cardiology, University of Siena, Siena, Italy
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21
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Zhou W, Lee JCY, Leung ST, Lai A, Lee TF, Chiang JB, Cheng YW, Chan HL, Yiu KH, Goh VKM, Pennell DJ, Ng MY. Long-Term Prognosis of Patients With Coronary Microvascular Disease Using Stress Perfusion Cardiac Magnetic Resonance. JACC Cardiovasc Imaging 2020; 14:602-611. [PMID: 33248966 DOI: 10.1016/j.jcmg.2020.09.034] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/20/2020] [Accepted: 09/03/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVES This study investigated the prognosis of coronary microvascular disease (CMD) as determined by stress perfusion cardiac magnetic resonance (CMR) in patients with ischemic symptoms but without significant coronary artery disease (CAD). BACKGROUND Patients with CMD have poorer prognosis with various cardiac diseases. The myocardial perfusion reserve index (MPRI) derived from noninvasive stress perfusion CMR has been established to diagnose microvascular angina with a threshold MPRI <1.4. The prognosis of CMD as determined by MPRI is unknown. METHODS Chest pain patients without epicardial CAD or myocardial disease from January 2009 to December 2017 were retrospectively included from 3 imaging centers in Hong Kong (HK). Stress perfusion CMR examinations were performed using either adenosine or adenosine triphosphate. Adequate stress was assessed by achieving splenic switch-off sign. Measurement of MPRI was performed in all stress perfusion CMR scans. Patients were followed for major adverse cardiovascular events defined as all-cause death, acute coronary syndrome (ACS), epicardial CAD development, heart failure hospitalization and non-fatal stroke. RESULTS A total of 218 patients were studied (mean age 59 ± 12 years; 49.5% male) and the average MPRI of that cohort was 1.56 ± 0.33. Females and a history of hyperlipidemia were predictors of lower MPRI. Major adverse cardiovascular events (MACE) occurred in 15.6% of patients during a median follow-up of 5.5 years (interquartile range: 4.6 to 6.8 years). The optimal cutoff value of MPRI in predicting MACE was found with a threshold MPRI ≤1.47. Patients with MPRI ≤1.47 had three-fold increased risk of MACE compared with those with MPRI >1.47 (hazard ratio [HR]: 3.14; 95% confidence interval [CI]: 1.58 to 6.25; p = 0.001). Multivariate Cox regression after adjusting for age and hypertension demonstrated that MPRI was an independent predictor of MACE (HR: 0.10; 95% CI: 0.03 to 0.34; p < 0.001). CONCLUSIONS Stress perfusion CMR-derived MPRI is an independent imaging marker that predicts MACE in patients with ischemic symptom and no overt CAD over the medium term.
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Affiliation(s)
- Wenli Zhou
- Department of Diagnostic Radiology, The University of Hong Kong, Hong Kong
| | | | - Siu Ting Leung
- Department of Radiology, Pamela Youde Nethersole Eastern Hospital, Hong Kong
| | - Alta Lai
- Department of Radiology, Pamela Youde Nethersole Eastern Hospital, Hong Kong
| | - Tang-Fei Lee
- Department of Radiology, Pamela Youde Nethersole Eastern Hospital, Hong Kong
| | | | - Yuet Wong Cheng
- Division of Cardiology, Department of Medicine, Queen Elizabeth Hospital, Hong Kong
| | - Hiu-Lam Chan
- Division of Cardiology, Department of Medicine, Pamela Youde Nethersole Eastern Hospital, Hong Kong
| | - Kai-Hang Yiu
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Hong Kong
| | - Victor King-Man Goh
- Hong Kong Sanatorium and Hospital, Hong Kong; School of Public Health, The Chinese University of Hong Kong, Hong Kong
| | - Dudley John Pennell
- Cardiovascular Magnetic Resonance Unit, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom; National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Ming-Yen Ng
- Department of Diagnostic Radiology, The University of Hong Kong, Hong Kong; Department of Medical Imaging, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China.
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22
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Advances and New Insights in Post-Transplant Care: From Sequencing to Imaging. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2020. [DOI: 10.1007/s11936-020-00828-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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23
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Chaikriangkrai K, Abbasi MA, Sarnari R, Dolan R, Lee D, Anderson AS, Ghafourian K, Khan SS, Vorovich EE, Rich JD, Wilcox JE, Blaisdell JA, Yancy CW, Carr J, Markl M. Prognostic Value of Myocardial Extracellular Volume Fraction and T2-mapping in Heart Transplant Patients. JACC Cardiovasc Imaging 2020; 13:1521-1530. [PMID: 32199848 PMCID: PMC8809107 DOI: 10.1016/j.jcmg.2020.01.014] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 01/22/2020] [Accepted: 01/30/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The purpose of this study was to examine prognostic value of T1- and T2-mapping techniques in heart transplant patients. BACKGROUND Myocardial characterization using T2 mapping (evaluation of edema/inflammation) and pre- and post-gadolinium contrast T1 mapping (calculation of extracellular volume fraction [ECV] for assessment of interstitial expansion/fibrosis) are emerging modalities that have been investigated in various cardiomyopathies. METHODS A total of 99 heart transplant patients underwent the magnetic resonance imaging (MRI) scans including T1- (n = 90) and T2-mapping (n = 79) techniques. Relevant clinical characteristics, MRI parameters including late gadolinium enhancement (LGE), and invasive hemodynamics were collected. Median clinical follow-up duration after the baseline scan was 2.4 to 3.5 years. Clinical outcomes include cardiac events (cardiac death, myocardial infarction, coronary revascularization, and heart failure hospitalization), noncardiac death and noncardiac hospitalization. RESULTS Overall, the global native T1, postcontrast T1, ECV, and T2 were 1,030 ± 56 ms, 458 ± 84 ms, 27 ± 4% and 50 ± 4 ms, respectively. Top-tercile-range ECV (ECV >29%) independently predicted adverse clinical outcomes compared with bottom-tercile-range ECV (ECV <25%) (hazard ratio [HR]: 2.87; 95% confidence interval [CI]: 1.07 to 7.68; p = 0.04) in a multivariable model with left ventricular end-systolic volume and LGE. Higher T2 (T2 ≥50.2 ms) independently predicted adverse clinical outcomes (HR: 3.01; 95% CI: 1.39 to 6.54; p = 0.005) after adjustment for left ventricular ejection fraction, left ventricular end-systolic volume, and LGE. Additionally, higher T2 (T2 ≥50.2 ms) also independently predicted cardiac events (HR: 4.92; CI: 1.60 to 15.14; p = 0.005) in a multivariable model with left ventricular ejection fraction. CONCLUSIONS MRI-derived myocardial ECV and T2 mapping in heart transplant patients were independently associated with cardiac and noncardiac outcomes. Our findings highlight the need for larger prospective studies.
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Affiliation(s)
- Kongkiat Chaikriangkrai
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
| | - Muhannad Aboud Abbasi
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Roberto Sarnari
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Ryan Dolan
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Daniel Lee
- Division of Cardiology, Department of Medicine, Northwestern University, Chicago, Illinois
| | - Allen S Anderson
- Division of Cardiology, Department of Medicine, Northwestern University, Chicago, Illinois
| | - Kambiz Ghafourian
- Division of Cardiology, Department of Medicine, Northwestern University, Chicago, Illinois
| | - Sadiya S Khan
- Division of Cardiology, Department of Medicine, Northwestern University, Chicago, Illinois
| | - Esther E Vorovich
- Division of Cardiology, Department of Medicine, Northwestern University, Chicago, Illinois
| | - Jonathan D Rich
- Division of Cardiology, Department of Medicine, Northwestern University, Chicago, Illinois
| | - Jane E Wilcox
- Division of Cardiology, Department of Medicine, Northwestern University, Chicago, Illinois
| | - Julie A Blaisdell
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Clyde W Yancy
- Division of Cardiology, Department of Medicine, Northwestern University, Chicago, Illinois
| | - James Carr
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Michael Markl
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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24
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Raman SV, Jarori U. Strain and Long-Term Prognosis After Heart Transplantation: A Necessary Advance in the Pursuit of Sufficient Understanding. JACC Cardiovasc Imaging 2020; 13:1943-1944. [PMID: 32563651 DOI: 10.1016/j.jcmg.2020.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 04/22/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Subha V Raman
- Indiana University School of Medicine, Krannert Institute of Cardiology, Indianapolis, Indiana.
| | - Upasana Jarori
- Indiana University School of Medicine, Krannert Institute of Cardiology, Indianapolis, Indiana
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25
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Cardiovascular magnetic resonance-derived myocardial strain in asymptomatic heart transplanted patients and its correlation with late gadolinium enhancement. Eur Radiol 2020; 30:4337-4346. [PMID: 32232791 DOI: 10.1007/s00330-020-06763-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 02/16/2020] [Accepted: 02/19/2020] [Indexed: 01/10/2023]
Abstract
OBJECTIVES To investigate whether cardiovascular magnetic resonance (CMR)-derived myocardial strains were abnormal in asymptomatic heart transplant (HT) patients with normal left ventricular ejection fraction (LVEF) and to detect the relationship between CMR-derived myocardial strain parameters and late gadolinium enhancement (LGE) in asymptomatic HT patients. METHODS A total of 72 HT patients and 35 healthy volunteers underwent 1.5-T MR scanning. The examination protocol included basic cine imaging and LGE. The deformation registration algorithm (DRA) and feature tracking (FT) software were used for the strain analyses. Myocardial strain measurements included left ventricular global longitudinal strain (LVGLS), LV global circumferential strain (LVGCS), LV global radial strain (LVGRS) and right ventricular longitudinal strain (RVLS). RESULTS Compared with healthy volunteers, HT patients had significantly decreased DRA- and FT- derived myocardial strain measurements (all p < 0.05). There was a significant correlation and high reproducibility between the DRA- and FT-derived strain parameters. Both CMR-derived LVGLS and LVGRS were significantly related to the presence of LGE, and multivariate logistic regression analyses showed that the LVGLS measurement obtained from both techniques was independently associated with the presence of LGE. The odds ratios (ORs) for DRA- and FT-LVGLS were 1.340 and 1.342, respectively. CONCLUSIONS Asymptomatic HT patients with preserved LVEF exhibited reduced myocardial strain parameters. The CMR-derived LVGLS was independently related to the presence of LGE in HT patients. KEY POINTS • Reduced myocardial strain parameters were found in asymptomatic heart transplanted (HT) patients with normal left ventricular ejection fraction (LVEF). • The deformation registration algorithm (DRA) and feature tracking (FT)-derived strains in asymptomatic HT patients had high reproducibility. • DRA- and FT-derived LVGLS had an independent relationship with late gadolinium enhancement (LGE) in asymptomatic HT patients.
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26
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Lee F, Nair V, Chih S. Cardiac allograft vasculopathy: Insights on pathogenesis and therapy. Clin Transplant 2020; 34:e13794. [PMID: 31991002 DOI: 10.1111/ctr.13794] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 01/14/2020] [Accepted: 01/23/2020] [Indexed: 12/21/2022]
Abstract
Cardiac allograft vasculopathy (CAV) is a unique accelerated form of coronary vascular disease affecting heart transplant recipients. This complication is a significant contributor to medium- to long-term post-transplant morbidity and mortality. There is a high prevalence of CAV with approximately one in three patients developing CAV by 5 years post-transplant. Morphologically, CAV is characterized by concentric coronary intimal hyperplasia in both the epicardial arteries and intramural microvasculature. Although several immune and non-immune factors have been identified, their precise pathogenic mechanisms, interactions, and relative importance in the development of CAV are not well defined. The advent of improved imaging surveillance modalities has resulted in earlier detection during the disease process. However, overall management of CAV remains challenging due to paucity of treatment. This review aims to discuss key concepts on the pathogenesis of CAV and current management strategies, focusing on the use of mammalian target of rapamycin inhibitors.
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Affiliation(s)
- Felicity Lee
- Heart Failure and Transplantation, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Vidhya Nair
- Department of Pathology and Laboratory Medicine, The Ottawa Hospital, Ottawa, ON, Canada
| | - Sharon Chih
- Heart Failure and Transplantation, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON, Canada
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27
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Dolan RS, Rahsepar AA, Blaisdell J, Sarnari R, Ghafourian K, Wilcox JE, Khan SS, Vorovich EE, Rich JD, Yancy CW, Anderson AS, Carr JC, Markl M. Donor and Recipient Characteristics in Heart Transplantation Are Associated with Altered Myocardial Tissue Structure and Cardiac Function. Radiol Cardiothorac Imaging 2019; 1:e190009. [PMID: 32076670 PMCID: PMC6939741 DOI: 10.1148/ryct.2019190009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 08/06/2019] [Accepted: 09/09/2019] [Indexed: 06/10/2023]
Abstract
PURPOSE To use structure-function cardiac MRI in the evaluation of relationships between donor and heart transplantation (HTx) recipient characteristics and changes in cardiac tissue structure and function. HTx candidates and donor hearts are evaluated for donor-recipient matches to improve survival, but the impact of donor and recipient characteristics on changes in myocardial tissue and function in the transplanted heart is not fully understood. MATERIALS AND METHODS Cardiac MRI at 1.5 T was performed from August 2014 to June 2017 in 58 HTx recipients (mean age, 51.1 years ± 12.6 [standard deviation], 26 female patients) and included T2 mapping (to evaluate edematous and/or inflammatory changes), precontrast and postcontrast T1 mapping (allowing the calculation of extracellular volume fraction [ECV] to estimate interstitial expansion), and tissue phase mapping (allowing the calculation of myocardial velocities and twist). Donor and recipient demographics (age, sex, height, weight, and body mass index [BMI]) and comorbidities (hypertension, diabetes, and smoking history) were evaluated for relationships with cardiac MRI measures. RESULTS Sex-influenced cardiac MRI measures of myocardial tissue and function are as follows: Female HTx recipients demonstrated increased precontrast T1 (P = .002) and reduced systolic peak long-axis velocities (P = .015). Increased age of the donor heart was associated with elevated T2 (r = 0.32; P < .05) and ECV (r = 0.47; P < .01), indicating increased edema and interstitial expansion, as well as impaired diastolic peak long-axis velocities (r = 0.41; P < .01). Recipient-donor differences in age, weight, and BMI were significantly associated with elevated ECV (r = 0.36-0.48; P < .05). Hypertension in donors resulted in increased ECV (31.0% ± 4.2 vs 26.0% ± 3.3; P = .001). CONCLUSION Donor and HTx recipient characteristics were significantly associated with cardiac MRI-derived measures of myocardial tissue structure and function.© RSNA, 2019.
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Affiliation(s)
- Ryan S. Dolan
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611 (R.S.D., A.A.R., J.B., R.S., J.C.C., M.M.); Department of Cardiology, Northwestern University, Chicago, Ill (K.G., J.E.W., S.S.K., E.E.V., J.D.R., C.W.Y., A.S.A.); and Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Ill (M.M.)
| | - Amir A. Rahsepar
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611 (R.S.D., A.A.R., J.B., R.S., J.C.C., M.M.); Department of Cardiology, Northwestern University, Chicago, Ill (K.G., J.E.W., S.S.K., E.E.V., J.D.R., C.W.Y., A.S.A.); and Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Ill (M.M.)
| | - Julie Blaisdell
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611 (R.S.D., A.A.R., J.B., R.S., J.C.C., M.M.); Department of Cardiology, Northwestern University, Chicago, Ill (K.G., J.E.W., S.S.K., E.E.V., J.D.R., C.W.Y., A.S.A.); and Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Ill (M.M.)
| | - Roberto Sarnari
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611 (R.S.D., A.A.R., J.B., R.S., J.C.C., M.M.); Department of Cardiology, Northwestern University, Chicago, Ill (K.G., J.E.W., S.S.K., E.E.V., J.D.R., C.W.Y., A.S.A.); and Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Ill (M.M.)
| | - Kambiz Ghafourian
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611 (R.S.D., A.A.R., J.B., R.S., J.C.C., M.M.); Department of Cardiology, Northwestern University, Chicago, Ill (K.G., J.E.W., S.S.K., E.E.V., J.D.R., C.W.Y., A.S.A.); and Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Ill (M.M.)
| | - Jane E. Wilcox
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611 (R.S.D., A.A.R., J.B., R.S., J.C.C., M.M.); Department of Cardiology, Northwestern University, Chicago, Ill (K.G., J.E.W., S.S.K., E.E.V., J.D.R., C.W.Y., A.S.A.); and Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Ill (M.M.)
| | - Sadiya S. Khan
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611 (R.S.D., A.A.R., J.B., R.S., J.C.C., M.M.); Department of Cardiology, Northwestern University, Chicago, Ill (K.G., J.E.W., S.S.K., E.E.V., J.D.R., C.W.Y., A.S.A.); and Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Ill (M.M.)
| | - Esther E. Vorovich
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611 (R.S.D., A.A.R., J.B., R.S., J.C.C., M.M.); Department of Cardiology, Northwestern University, Chicago, Ill (K.G., J.E.W., S.S.K., E.E.V., J.D.R., C.W.Y., A.S.A.); and Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Ill (M.M.)
| | - Jonathan D. Rich
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611 (R.S.D., A.A.R., J.B., R.S., J.C.C., M.M.); Department of Cardiology, Northwestern University, Chicago, Ill (K.G., J.E.W., S.S.K., E.E.V., J.D.R., C.W.Y., A.S.A.); and Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Ill (M.M.)
| | - Clyde W. Yancy
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611 (R.S.D., A.A.R., J.B., R.S., J.C.C., M.M.); Department of Cardiology, Northwestern University, Chicago, Ill (K.G., J.E.W., S.S.K., E.E.V., J.D.R., C.W.Y., A.S.A.); and Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Ill (M.M.)
| | - Allen S. Anderson
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611 (R.S.D., A.A.R., J.B., R.S., J.C.C., M.M.); Department of Cardiology, Northwestern University, Chicago, Ill (K.G., J.E.W., S.S.K., E.E.V., J.D.R., C.W.Y., A.S.A.); and Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Ill (M.M.)
| | - James C. Carr
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611 (R.S.D., A.A.R., J.B., R.S., J.C.C., M.M.); Department of Cardiology, Northwestern University, Chicago, Ill (K.G., J.E.W., S.S.K., E.E.V., J.D.R., C.W.Y., A.S.A.); and Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Ill (M.M.)
| | - Michael Markl
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611 (R.S.D., A.A.R., J.B., R.S., J.C.C., M.M.); Department of Cardiology, Northwestern University, Chicago, Ill (K.G., J.E.W., S.S.K., E.E.V., J.D.R., C.W.Y., A.S.A.); and Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Ill (M.M.)
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Abstract
The assessment of pediatric patients after orthotropic heart transplantation (OHT) relies heavily on non-invasive imaging. Because of the potential risks associated with cardiac catheterization, expanding the role of non-invasive imaging is appealing. Echocardiography is fast, widely available, and can provide an accurate assessment of chamber sizes and function. Advanced echocardiographic methods, such as myocardial deformation, have potential to assess for acute rejection or cardiac allograft vasculopathy (CAV). While not currently part of routine care, cardiac magnetic resonance imaging (CMR) and computed tomography may potentially aid in the detection of graft complications following OHT. In particular, CMR tissue characterization holds promise for diagnosing rejection, while quantitative perfusion and myocardial late gadolinium enhancement may have a role in the detection of CAV. This review will evaluate standard and novel methods for non-invasive assessment of pediatric patients after OHT.
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Affiliation(s)
- Jonathan H Soslow
- Thomas P. Graham Jr. Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Margaret M Samyn
- Medical College of Wisconsin, Pediatrics (Cardiology), Herma Heart Institute, Children's Hospital of Wisconsin, Milwaukee, WI, USA
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29
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Nikolova AP, Kobashigawa JA. Cardiac Allograft Vasculopathy: The Enduring Enemy of Cardiac Transplantation. Transplantation 2019; 103:1338-1348. [PMID: 31241553 DOI: 10.1097/tp.0000000000002704] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Cardiac allograft vasculopathy remains a major limiting factor in the long-term survival of the heart transplant recipient. Our understanding of its pathogenesis is continuously evolving as advances in imaging modalities have allowed a direct window into the natural history of the disease. Innovation in diagnostic modalities has spurred the proliferation of prognostic tools and biomarkers. And in parallel, pharmacological advances have emerged that have helped ameliorate the disease's progressive course.
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Affiliation(s)
- Andriana P Nikolova
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Jon A Kobashigawa
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA
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30
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Watanabe K, Schäfer M, Cassidy C, Miyamoto SD, Jone PN. Right atrial function in pediatric heart transplant patients by echocardiographic strain measurements. Pediatr Transplant 2019; 23:e13383. [PMID: 30866164 DOI: 10.1111/petr.13383] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 12/13/2018] [Accepted: 01/21/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND CAV is a major cause of mortality in PHTx patients. Research on echocardiographic indices to detect CAV focuses primarily on ventricular function and less is known about RAF. Thus, we primarily sought to evaluate RAF in PHTx patients with CAV. For secondary analysis, we compared RAF between PHTx patients and control patients and evaluated RAF with respect to rejection and surgical type. METHODS We retrospectively evaluated echocardiography derived RA strain indices in recipients <18 years old and >1 year from time of transplant. The RA strain phases included, reservoir (εs), conduit (εe), pump (εa), and respective strain rate indices (SRs, SRe, SRa). RESULTS There were 36 PHTx patients and 14 age-, sex-matched control patients. There was a significant reduction in εs, εe, SRs, and SRe (P < 0.001) in the PHTx patients when compared to controls. There was no difference between the CAV (+) and CAV (-) patients with respect to RAF indices. Furthermore, εs, εe, and SRe (P < 0.05) were lower in patients with acute rejection (n = 7) compared to those without (n = 26). Patients with a bi-atrial anastomosis (n = 14) had decreased εs, εa, SRs, SRa (P < 0.05), compared to bi-caval anastomosis (n = 24). CONCLUSION PHTx patients have decreased RAF compared to healthy children. RAF does not differentiate PHTx patients based on the presence of CAV. RAF is also decreased in PHTx patients with rejection and in those transplanted with a bi-atrial anastomosis.
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Affiliation(s)
- Kae Watanabe
- Division of Cardiology, Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado.,Division of Cardiology, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Michal Schäfer
- Division of Cardiology, Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado
| | - Courtney Cassidy
- Division of Cardiology, Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado
| | - Shelley D Miyamoto
- Division of Cardiology, Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado
| | - Pei-Ni Jone
- Division of Cardiology, Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado
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31
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Sensitization to endothelial cell antigens: Unraveling the cause or effect paradox. Hum Immunol 2019; 80:614-620. [PMID: 31054781 DOI: 10.1016/j.humimm.2019.04.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 04/02/2019] [Accepted: 04/23/2019] [Indexed: 01/03/2023]
Abstract
Anti-endothelial cell antibodies (AECAs) have been correlated with increased acute and chronic rejection across all organ types and early graft dysfunction in kidney and heart transplantation. Nevertheless, the lack of appropriate tools and clear criteria for defining injurious versus non-injurious AECAs prohibits their routine inclusion in clinical risk assessments and diagnostic algorithms for antibody mediated injury. Clinical characterization of AECAs is complicated due to the wide range of polymorphic and non-polymorphic antigens expressed across different vascular tissues and the diverse array of specificities observed between individuals. This complexity is also reflected in the broad spectrum of reported injury phenotypes. AECAs detected at time of allograft dysfunction may represent biomarkers of past vascular injury or active contributors to a current rejection process. New tools within the fields of proteomics, genomics, bioinformatics, and imaging are currently being validated and hold great promise for unraveling the AECA paradox.
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Korosoglou G, Giusca S, Hofmann NP, Patel AR, Lapinskas T, Pieske B, Steen H, Katus HA, Kelle S. Strain-encoded magnetic resonance: a method for the assessment of myocardial deformation. ESC Heart Fail 2019; 6:584-602. [PMID: 31021534 PMCID: PMC6676282 DOI: 10.1002/ehf2.12442] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 03/28/2019] [Indexed: 12/26/2022] Open
Abstract
This study aims to assess the usefulness of strain‐encoded magnetic resonance (SENC) for the quantification of myocardial deformation (‘strain’) in healthy volunteers and for the diagnostic workup of patients with different cardiovascular pathologies. SENC was initially described in the year 2001. Since then, the SENC sequence has undergone several technical developments, aiming at the detection of strain during single‐heartbeat acquisitions (fast‐SENC). Experimental and clinical studies that used SENC and fast‐SENC or compared SENC with conventional cine or tagged magnetic resonance in phantoms, animals, healthy volunteers, or patients were systematically searched for in PubMed. Using ‘strain‐encoded magnetic resonance and SENC’ as keywords, three phantom and three animal studies were identified, along with 27 further clinical studies, involving 185 healthy subjects and 904 patients. SENC (i) enabled reproducible assessment of myocardial deformation in vitro, in animals and in healthy volunteers, (ii) showed high reproducibility and substantially lower time spent compared with conventional tagging, (iii) exhibited incremental value to standard cine imaging for the detection of inducible ischaemia and for the risk stratification of patients with ischaemic heart disease, and (iv) enabled the diagnostic classification of patients with transplant vasculopathy, cardiomyopathies, pulmonary hypertension, and diabetic heart disease. SENC has the potential to detect a wide range of myocardial diseases early, accurately, and without the need of contrast agent injection, possibly enabling the initiation of specific cardiac therapies during earlier disease stages. Its one‐heartbeat acquisition mode during free breathing results in shorter cardiovascular magnetic resonance protocols, making its implementation in the clinical realm promising.
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Affiliation(s)
- Grigorios Korosoglou
- Departments of Cardiology, Vascular Medicine and Pneumology, GRN Hospital Weinheim, Weinheim, Germany
| | - Sorin Giusca
- Departments of Cardiology, Vascular Medicine and Pneumology, GRN Hospital Weinheim, Weinheim, Germany
| | - Nina P Hofmann
- Departments of Cardiology, Vascular Medicine and Pneumology, GRN Hospital Weinheim, Weinheim, Germany
| | - Amit R Patel
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Tomas Lapinskas
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Burkert Pieske
- Department of Internal Medicine, Cardiology German Heart Center Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.,Department of Internal Medicine/Cardiology, Charité Campus Virchow Clinic, Berlin, Germany
| | - Henning Steen
- Department of Cardiology, Marien Hospital Hamburg, Hamburg, Germany
| | - Hugo A Katus
- Departments of Cardiology, Angiology and Pneumology, Heidelberg University, Heidelberg, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Sebastian Kelle
- Department of Internal Medicine, Cardiology German Heart Center Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.,Department of Internal Medicine/Cardiology, Charité Campus Virchow Clinic, Berlin, Germany
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Reduced Biventricular Volumes and Myocardial Dysfunction Long-term After Pediatric Heart Transplantation Assessed by CMR. Transplantation 2019; 103:2682-2691. [PMID: 30964835 DOI: 10.1097/tp.0000000000002738] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Long-term cardiac remodeling after heart transplantation (HT) in children has been insufficiently characterized. The aim of our study was to evaluate ventricular size in HT patients using cardiovascular magnetic resonance (CMR) imaging, to find underlying factors related to potentially abnormal cardiac dimensions and to study its impact on functional class and ventricular function. METHODS Seventy-five pediatric HT recipients (age 14.0 ± 4.2 y) were assessed by using CMR 11.2 ± 5.4 years after HT. Right ventricular (RV) and left ventricular (LV) volumes and mass were derived from short-axis cine images and myocardial strain/strain rate was assessed using myocardial feature tracking technique. Results were compared with a healthy reference population (n = 79, age 13.7 ± 3.7 y). RESULTS LV end-diastolic ventricular volumes were smaller (64 ± 12 versus 84 ± 12 mL/m; P < 0.001) while mass-to-volume ratio (0.86 ± 0.18 versus 0.65 ± 0.11; P < 0.001) and heart rate (92 ± 14 versus 78 ± 13 beats/min; P < 0.001) were higher in HT patients. LV-ejection fraction (EF) was preserved (66% ± 8% versus 64% ± 6%; P = 0.18) but RV-EF (58 ± 7 versus 62% ± 4%, P = 0.004), LV systolic longitudinal strain (-12 ± 6 versus -15% ± 5%; P = 0.05), diastolic strain rate (1.2 ± 0.6 versus 1.5 ± 0.6 1/s; P = 0.03), and intra and interventricular synchrony were lower in the HT group. Smaller LV dimensions were primarily related to longer follow-up time since HT (β = -0.38; P < 0.001) and were associated with worse functional class and impaired ventricular systolic and diastolic performance. CONCLUSIONS Cardiac remodeling after pediatric HT is characterized by reduced biventricular size and increased mass-to-volume ratio. These adverse changes evolve gradually and are associated with impaired functional class and ventricular dysfunction suggesting chronic maladaptive processes affecting allograft health.
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34
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Law Y. The Optics of Optical Coherence Tomography: Let the Race Begin! JACC Cardiovasc Imaging 2019; 12:2502-2504. [PMID: 30660529 DOI: 10.1016/j.jcmg.2018.07.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 07/05/2018] [Accepted: 07/12/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Yuk Law
- Cardiac Transplant and Heart Failure Services, Seattle Children's Hospital, Seattle, Washington.
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35
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Olymbios M, Kwiecinski J, Berman DS, Kobashigawa JA. Imaging in Heart Transplant Patients. JACC Cardiovasc Imaging 2018; 11:1514-1530. [DOI: 10.1016/j.jcmg.2018.06.019] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 04/30/2018] [Accepted: 06/07/2018] [Indexed: 01/06/2023]
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Narang A, Blair JE, Patel MB, Mor-Avi V, Fedson SE, Uriel N, Lang RM, Patel AR. Myocardial perfusion reserve and global longitudinal strain as potential markers of coronary allograft vasculopathy in late-stage orthotopic heart transplantation. Int J Cardiovasc Imaging 2018; 34:1607-1617. [PMID: 29728952 PMCID: PMC6160357 DOI: 10.1007/s10554-018-1364-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 04/29/2018] [Indexed: 12/30/2022]
Abstract
Coronary allograft vasculopathy (CAV) is a major cause of mortality in late-stage orthotopic heart transplantation (OHT) patients. Recent evidence has shown that myocardial perfusion reserve (MPR) derived from vasodilator cardiovascular magnetic resonance imaging (vCMR) and global longitudinal strain (GLS) from transthoracic echocardiography (TTE) are useful to detect CAV. However, previous studies have not comprehensively addressed whether these parameters are confounded by allograft rejection, myocardial scar/fibrosis, or allograft dysfunction. Our aim was to determine whether changes in late post-OHT MPR and GLS are due to CAV or other confounding factors. Twenty OHT patients (time from transplant to vCMR was 8.1 ± 4.1 years) and 30 controls (10 healthy volunteers and 20 with prior myocardial infarction to provide perspective with regards to the severity of any abnormalities seen in post-OHT patients) underwent vasodilator vCMR from which MPR index (MPRi), left ventricular ejection fraction (LVEF), and burden of late gadolinium enhancement (LGE) were quantified. TTE was used to measure GLS. The presence of CAV was determined from invasive coronary angiograms using thrombolysis in myocardial infarction (TIMI) frame counts and grading severity per guidelines. Previous endomyocardial biopsies were reviewed to assess association with episodes of rejection. We examined the correlations between MPRi and GLS with markers of CAV, allograft function, scar/fibrosis, and rejection. MPRi was abnormal in post-OHT patients compared to both healthy volunteers and MI controls. While there was no relationship between MPRi or GLS and LVEF, episodes of rejection, or LGE burden, both MPRi and GLS were associated with TIMI frame counts and presence and severity of CAV. Additionally, MPRi correlated with GLS (R = 0.68, P = 0.0002). In conclusion, MPRi and GLS are abnormal in late-stage OHT and associated with CAV, but not related to allograft rejection, myocardial scar/fibrosis, or allograft dysfunction. Non-invasive monitoring of MPRi and GLS may be a useful strategy to detect CAV.
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Affiliation(s)
- Akhil Narang
- Department of Medicine, University of Chicago Medicine, 5758 S. Maryland Avenue, MC9067, Chicago, IL, 60637, USA
| | - John E Blair
- Department of Medicine, University of Chicago Medicine, 5758 S. Maryland Avenue, MC9067, Chicago, IL, 60637, USA
| | - Mita B Patel
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Victor Mor-Avi
- Department of Medicine, University of Chicago Medicine, 5758 S. Maryland Avenue, MC9067, Chicago, IL, 60637, USA
| | - Savitri E Fedson
- Center for Medical Ethics and Health Policy, Baylor School of Medicine, Houston, TX, USA
| | - Nir Uriel
- Department of Medicine, University of Chicago Medicine, 5758 S. Maryland Avenue, MC9067, Chicago, IL, 60637, USA
| | - Roberto M Lang
- Department of Medicine, University of Chicago Medicine, 5758 S. Maryland Avenue, MC9067, Chicago, IL, 60637, USA
- Department of Radiology, University of Chicago, Chicago, IL, USA
| | - Amit R Patel
- Department of Medicine, University of Chicago Medicine, 5758 S. Maryland Avenue, MC9067, Chicago, IL, 60637, USA.
- Department of Radiology, University of Chicago, Chicago, IL, USA.
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Kindel SJ, Hsu HH, Hussain T, Johnson JN, McMahon CJ, Kutty S. Multimodality Noninvasive Imaging in the Monitoring of Pediatric Heart Transplantation. J Am Soc Echocardiogr 2017; 30:859-870. [DOI: 10.1016/j.echo.2017.06.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Indexed: 01/09/2023]
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38
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McCann GP, Miller CA. Diagnosing Cardiac Allograft Vasculopathy: Focusing on the Little Things... JACC Cardiovasc Imaging 2016; 9:267-8. [PMID: 26965730 DOI: 10.1016/j.jcmg.2015.10.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 10/29/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Gerry P McCann
- Department of Cardiovascular Sciences, University of Leicester and the National Institute for Health Research, Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester, United Kingdom.
| | - Christopher A Miller
- Cardiovascular Research Group, Institute of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
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Marwick TH, Chandrashekhar Y, Narula J. Imaging and the Valley of Death: Developing the Evidence Base for the Use of Imaging in Follow-Up. JACC Cardiovasc Imaging 2016; 9:332-4. [PMID: 26965740 DOI: 10.1016/j.jcmg.2016.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
| | - Y Chandrashekhar
- University of Minnesota & VA Medical Center, Minneapolis, Minnesota
| | - Jagat Narula
- Icahn School of Medicine at Mount Sinai, New York, New York.
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