Author + information
- Received September 21, 2017
- Revision received September 17, 2018
- Accepted October 26, 2018
- Published online August 5, 2019.
- Muhammad Imran, MBBSa,∗ (, )
- Louis Wang, MBBSa,
- Jane McCrohon, MBBBa,
- Chung Yu, MBBSa,
- Cameron Holloway, MBBSa,
- James Otton, MBBSa,
- Justyn Huang, MBBSa,
- Christian Stehning, PhDb,
- Kirsten Jane Moffat, BAppScc,
- Joanne Rossc,
- Valentina O. Puntmann, MDd,
- Vassilios S. Vassiliou, MBBSe,
- Sanjay Prasad, MBBSe,
- Eugene Kotlyar, MBBSa,
- Anne Keogh, MBBSa,
- Christopher Hayward, MBBSa,
- Peter Macdonald, MBBSa and
- Andrew Jabbour, MBBSa
- aHeart and Lung Transplant Unit, St. Vincent’s Hospital, Sydney, Australia
- bPhilips GmbH Innovative Technologies, Hamburg, Germany
- cMedical Imaging Department, St. Vincent’s Hospital, Sydney, Australia
- dInstitute for Experimental and Translational Cardiovascular Imaging, Goethe University Hospital, Frankfurt, Germany
- eCMR, Royal Brompton Hospital, Imperial College London, London, United Kingdom
- ↵∗Address for correspondence:
Dr. Muhammad Imran, Heart and Lung Transplant Unit, St. Vincent’s Hospital, 390 Victoria Street, Darlinghurst, NSW 2010, Australia.
Objectives This study aimed to determine the role of T1 mapping in identifying cardiac allograft rejection.
Background Endomyocardial biopsy (EMBx), the current gold standard to diagnose cardiac allograft rejection, is associated with potentially serious complications. Cardiac magnetic resonance (CMR)–based T1 mapping detects interstitial edema and fibrosis, which are important markers of acute and chronic rejection. Therefore, T1 mapping can potentially diagnose cardiac allograft rejection noninvasively.
Methods Patients underwent CMR within 24 h of EMBx. T1 maps were acquired at 1.5-T. EMBx-determined rejection was graded according to International Society of Heart and Lung Transplant (ISHLT) criteria.
Results Of 112 biopsies with simultaneous CMR, 60 were classified as group 0 (ISHLT grade 0), 35 as group 1 (ISHLT grade 1R), and 17 as group 2 (2R, 3R, clinically diagnosed rejection, antibody-mediated rejection). Native T1 values in patients with grade 0 biopsies and left ventricular ejection fraction >60% (983 ± 42 ms; 95% confidence interval: 972 to 994 ms) were comparable to values in nontransplant healthy control subjects (974 ± 45 ms; 95% confidence interval: 962 to 987 ms). T1 values were significantly higher in group 2 (1,066 ± 78 ms) versus group 0 (984 ± 42 ms; p = 0.0001) and versus group 1 (1,001 ± 54 ms; p = 0.001). After excluding patients with an estimated glomerular filtration rate <50 ml/min/m2, there was a moderate correlation of log-transformed native T1 with high-sensitivity troponin T (r = 0.54, p < 0.0001) and pro–B-type natriuretic peptide (r = 0.67, p < 0.0001). Using a T1 cutoff value of 1,029 ms, the sensitivity, specificity, and negative predictive value were 93%, 79%, and 99%, respectively.
Conclusions Myocardial tissue characterization with T1 mapping displays excellent negative predictive capacity for the noninvasive detection of cardiac allograft rejection and holds promise to reduce substantially the EMBx requirement in cardiac transplant rejection surveillance.
The study was funded by the National Health and Medical Research Council and St. Vincent’s Clinical Foundation, Australia. Dr. Stening has been employed by Philips Healthcare. Dr. Keogh has conducted clinical trial research for Actelion, Pfizer, United Therapeutics, Arena, Acceleron, Bayer, Respira, GlaxoSmithKline, and Gilead. Dr. Macdonald has received an institutional research grant from Novartis; has been on the advisory boards of Novartis and AstraZeneca; has received speaker honoraria from Servier; and has received travel support from Transmedics. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received September 21, 2017.
- Revision received September 17, 2018.
- Accepted October 26, 2018.
- 2019 American College of Cardiology Foundation
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