The diagnosis of acute rejection in cardiac transplant recipients requires invasive technique with endomyocardial biopsy (EMB) which has risks and limitations. Cardiovascular magnetic resonance ...imaging (CMR) with T2 and T1 mapping is a promising technique for characterizing myocardial tissue. The purpose of the study was to evaluate T2, T1 and extracellular volume fraction (ECV) quantification as novel tissue markers to diagnose acute rejection.
CMR was prospectively performed in 20 heart transplant patients providing 31 comparisons EMB-CMR. CMR was performed close to EMB. Images were acquired on a 1.5 Tesla scanner including T2 mapping (T2 prepared balanced steady state free precession) and T1 mapping (modified Look-Locker inversion recovery sequences: MOLLI) at basal, mid and apical level in short axis view. Global and segmental T2 and T1 values were measured before and 15 min (for T1 mapping) after contrast administration.
Acute rejection was diagnosed in seven patients: six cellular rejections (4 grade IR, 2 grade 2R) and one antibody mediated rejection. Patients with acute rejection had significantly higher global T2 values at 3 levels: 58.5 ms 55.0-60.3 vs 51.3 ms 49.5-55.2 (p = 0.007) at basal; 55.7 ms 54.0-59.7 vs 51.8 ms 50.1-53.6 (p = 0.002) at median and 58.2 ms 54.0-63.7 vs 53.6 ms 50.8-57.4 (p = 0.026) at apical level. The area under the curve (AUC) for each level was 0.83, 0.79 and 0.78 respectively. Patients with acute rejection had significantly higher ECV at basal level: 34.2% 32.8-37.4 vs 27.4% 24.6-30.6 (p = 0.006). The AUC for basal level was 0.84. The sensitivity, specificity and diagnosis accuracy for basal T2 (cut off: 57.7 ms) were 71, 96 and 90% respectively; and for basal ECV: (cut off 32%) were 86, 85 and 85% respectively. Combining basal T2 and basal ECV allowed diagnosing all acute rejection and avoiding 63% of EMB.
In heart transplant patients, a combined CMR approach using T2 mapping and ECV quantification provides a high diagnostic accuracy for acute rejection diagnosis and could potentially decrease the number of routine EMB.
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DOBA, GEOZS, IJS, IMTLJ, IZUM, KILJ, KISLJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBJE, UILJ, UKNU, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Left ventricular thrombus (LVT) is a serious post-myocardial infarction complication which increases length of hospital stay and cost of hospitalization but above all, leads to severe consequences ...when responsible for systemic embolization or cerebral stroke (up to 15% of patients with LVT).
Evaluate the prevalence of LVT after ST-segment elevated myocardial Infarction (STEMI) by trans thoracic echocardiography (TTE) and cardiac magnetic resonance (CMR), identify risk factors and better screening strategy.
In total, 330 patients were included in three prospective studies requiring TTE and CMR in the aftermath of a STEMI. In total, 136 patients finally underwent both of these exams.
Twelve LVT were detected (8.8% of post-STEMI patients) including 5 only by CMR and one only by TTE.
With an univariate analysis, we observed more LVT in patients with a left anterior descending (LAD) involved (100% vs. 46%; P<0.001), EKG anterior STEMI (100% vs. 47%; P<0.001), lower left ventricular ejection fraction (LVEF) at baseline (35% vs. 46%; P<0.001) and after revascularization (45% vs. 52%; P<0.001), LV aneurysm (42% vs. 2%; P<0.001), anterior akinesia (75% vs. 20%; P<0.001), apical akinesia (92% vs. 31%; P<0.001), higher indexed LV end-diastolic and end-systolic volumes (65 vs. 55mL/m2; P=0.04, 38 vs. 27mL/m2P<0.01), lower left ventricular outflow tract velocity time integral (LVOT VTI) (17 vs. 19cm/s; P<0.01) and global longitudinal strain (−10 vs. −14%; P=0.02), fever (33% vs. 12% P=0.04), lower creatinine level (65 vs. 76μmol/L; P=0.04), higher glomerular filtration rate (110 vs. 95mL/min/m2; P=0.01) and Creatin Kinase peak (5773 vs. 2776 UI/L; P<0.001) (Fig. 1).
LVT remains common after STEMI, even more in certain subgroups of patients like anteriors ones, those with altered LVEF and/or dilated LV.
CMR allows better diagnosis than TTE, but, because of its availability, the nature of the examinations to carry out and their timing remains to be defined.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Abstract Objective Longitudinal shortening is traditionally considered the predominant part of global right ventricular (RV) systolic function. Less attention has been paid to transverse contraction. ...The aim of this study was to evaluate RV transverse motion by cardiovascular magnetic resonance (CMR) in a large cohort of patients and to assess its relationship with RV ejection fraction (RVEF). Study design We retrospectively analyzed the CMR scans of 300 patients referred to our center in 2010. RVEF was determined from short axis sequences using the volumetric method. Transverse parameters called RV fractional diameter changes were calculated after measuring RV diastolic and systolic diameters at basal and mid-level in short axis view (respectively FBDC and FMDC). We also measured the tricuspid annular plane systolic excursion (TAPSE) as a longitudinal reference. Results Our population was divided into 2 groups according to RVEF. 250 patients had a preserved RVEF (>40%) and 50 had a RV dysfunction (RVEF ≤40%). Transverse and longitudinal motions were significantly reduced in the group with RV dysfunction ( p < .0001). After ROC analysis, areas under the curve for FBDC, FMDC and TAPSE, were respectively 0.79, 0.82 and 0.72, with the highest specificity and sensitivity respectively of 88% and 68% for FMDC (threshold at 20%) for predicting RV dysfunction. FMDC had an excellent negative predictive value of 93%. Conclusion RV fractional diameter changes, especially at the mid-level, appear to be accurate for semi-quantitative assessment of RV function by CMR. A cut-off of 20% for FMDC differentiates patients with a low (EF ≤ 40%) or a preserved RVEF.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Antibody-mediated rejection (AMR) is characterized by histopathological and immunophenotypic findings such as activated endothelial cells, intravascular macrophages and evidence of capillary C4d ...deposition. This inflammatory reaction could be followed by diffuse fibrosis. Cardiac magnetic resonance (CMR) with recently T1 mapping is a promising technique to identify diffuse myocardial fibrosis. The purpose of this study was to assess T1 mapping in patients with AMR.
2 patients with clinical AMR (histopathological and immunophenotypic findings, presence of donor-specific allo antibodies and allograft dysfunction) performed a CMR study one week (for the first patient) and 3 weeks (for the second patient) after the treatment of AMR (plasmapheresis, IV Immunoglobulins and Rituximab). Images were acquired on a 1.5 Tesla scanner (Siemens) including T1 mapping using a shortened modified look-locker inversion-recovery sequence and T2 mapping in a matched mid-ventricular short axis slice using a black- blood single shot fast spin echo pulse sequence. Segmental and global T1 values were measured before and 15 minutes after administration of 0.2mmol/kg of Gadoteric acid and compared to our cohort of 17 controls.
Mean non contrast T1 values were significantly higher in heart transplants patients compared to controls (1100±5ms vs 947±29ms, P<0.001). Segmental T1 values were significantly higher in the 6 regions of interest compared to controls (P <0.001 in all segments). Mean post contrast T1 values were not significantly different in patients and controls. Mean T2 value was higher in patients compared to controls (73±13 vs 50± 4ms), suggesting the presence of global edema.
Heart transplant patients with clinical antibody-mediated rejection show a significant increased global and segmental non contrast T1 values suggesting the presence of diffuse myocardial fibrosis. Further studies are required to confirm these data.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
T2- and T1-mapping are novel CMR techniques allowing tissue characterization.
To assess myocardial involvement using T2- and T1-mapping in Tako-Tsubo cardiomyopathy (TC).
9 patients with TC and 15 ...controls were prospectively enrolled. Cardiovascular magnetic resonance (CMR) was performed a mean 2.8 days after the onset of symptoms and after a mean 4.6 month follow-up. CMR was applied using T2-mapping, pre and post contrast T1-mapping (MOLLI) and late gadolinium enhancement (LGE) sequences. Segmental and global T1 values have been measured before and after contrast administration.
All patients were female, had positive troponin (6±9µg/l) and medium and/or apical ballooning associated with moderate LV dysfunction (EF 44±7%). On admission, compared with controls, TC patients had significantly higher T2 values (65±6ms vs 50±4ms, p<0.0001). Myocardial T2 was significantly higher in segments with Wall motion abnormality (WMA) compared to normokinetic segments (67±12ms vs 61.5±8ms, p=0.003). Compared with controls, TC patients had significantly higher pre contrast T1 values (1115±92 versus 1016±89, p<0.0001) and significantly lower post contrast T1 values (428±24ms vs 466±19ms, p=0.02).Pre contrast T1 values were significantly higher in segments with WMA compared to normal segments (1126±95 vs 1089±85, p=0.016).
Post contrast T1 values were not significantly different in abnormal segments compared to normal segments (421±56 vs 431±50, p=0.15). No patients had LGE. At follow-up: all had a complete LV recovery (EF: 67±4%) without significant WMA. Mean T2 and pre contrast T1 values decreased significantly (53±6ms vs 65±8ms, p=0.001 and 1016±76 vs 1115±80, p=0.001 respectively). No differences were observed regarding post contrast T1 values.
In TC patients, T2-mapping and pre contrast T1-mapping allow identification of reversible myocardial injury. Post contrast T1 mapping does not provide additional information.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
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