Cardiac Structure–Function MRI in Patients After Heart Transplantation

Ryan S. Dolan, Amir A. Rahsepar, Julie Blaisdell, Kai Lin, Kenichiro Suwa, Kambiz Ghafourian, Jane E Wilcox, Sadiya Sana Khan, Esther Elizabeth Vorovich, Jonathan D Rich, Allen Sawyer Anderson, Clyde W Yancy, Jeremy D Collins, Michael Markl*, James Carr

*Corresponding author for this work

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: Following heart transplantation (Tx), recipients are closely monitored using endomyocardial biopsy, which is limited by cost and invasiveness, and echocardiography, which is limited regarding detailed structural and functional evaluation. Purpose: To test the feasibility of comprehensive structure–function cardiac MRI as a noninvasive modality to assess changes in myocardial structure and function. Study Type: Prospective. Subjects: MR was performed in 61 heart transplant recipients (age 47.9 ± 16.3 years, 39% female) and 14 age-matched healthy controls (age 47.7 ± 16.7 years, 36% female). Field Strength/Sequence: 1.5T; 2D CINE steady state free precession (SSF)P imaging, T 2 -mapping, pre- and postgadolinium contrast T 1 -mapping, and tissue-phase mapping (TPM). Assessment: Quantification of myocardial T 2 (as a measure of edema), pre- and post-Gd T 1 (allowing calculation of extracellular volume (ECV) to estimate interstitial expansion), and TPM-based assessment of peak regional left ventricular (LV) velocities, dyssynchrony, and twist. Statistical Tests: Comparisons between transplant recipients and controls were performed using independent samples t-tests. Relationships between structural (T 2 , T 1 , ECV) and functional measures (myocardial velocities, dyssynchrony, twist) were assessed using Pearson correlation analysis. Results: T 2 and T 1 were significantly elevated in transplant recipients compared to controls (global T 2 : 50.5 ± 3.4 msec vs. 45.2 ± 2.3 msec, P < 0.01; global T 1 : 1037.8 ± 48.0 msec vs. 993.8 ± 34.1 msec, P < 0.01). Systolic longitudinal function was impaired in transplant recipients compared to controls (reduced peak systolic longitudinal velocities, 2.9 ± 1.1 cm/s vs. 5.1 ± 1.2 cm/s, P < 0.01; elevated systolic longitudinal dyssynchrony, 60.2 ± 30.2 msec vs. 32.1 ± 25.1 msec, P < 0.01). Correlation analysis revealed a significant positive relationship between T 2 and ECV (r = 0.45,P < 0.01). In addition, peak systolic longitudinal velocities demonstrated a significant inverse relationship with T 2 (global r = –0.29, P = 0.02), and systolic radial dyssynchrony was positively associated with peak T 2 and peak T 1 (r = 0.26,P = 0.04; r = 0.27,P = 0.03). Data Conclusion: MR techniques are sensitive to structural and functional differences in transplant recipients compared to controls. Structural (T 2 , T 1 ) and functional (peak myocardial velocities, dyssynchrony) measures were significantly associated, suggesting a structure–function relationship of cardiac abnormalities following heart transplant. Level of Evidence: 2. Technical Efficacy Stage: 2. J. Magn. Reson. Imaging 2019;49:678–687.

Original languageEnglish (US)
Pages (from-to)678-687
Number of pages10
JournalJournal of Magnetic Resonance Imaging
Volume49
Issue number3
DOIs
StatePublished - Mar 1 2019

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Heart Transplantation
Tissue Expansion
Congenital Heart Defects
Echocardiography
Edema
Transplant Recipients
Prospective Studies
Transplants
Biopsy
Costs and Cost Analysis

Keywords

  • T -mapping
  • T -mapping
  • cardiac
  • heart transplantation
  • tissue phase mapping

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

@article{0e6788c56f804ad7931656cfbc78f6cb,
title = "Cardiac Structure–Function MRI in Patients After Heart Transplantation",
abstract = "Background: Following heart transplantation (Tx), recipients are closely monitored using endomyocardial biopsy, which is limited by cost and invasiveness, and echocardiography, which is limited regarding detailed structural and functional evaluation. Purpose: To test the feasibility of comprehensive structure–function cardiac MRI as a noninvasive modality to assess changes in myocardial structure and function. Study Type: Prospective. Subjects: MR was performed in 61 heart transplant recipients (age 47.9 ± 16.3 years, 39{\%} female) and 14 age-matched healthy controls (age 47.7 ± 16.7 years, 36{\%} female). Field Strength/Sequence: 1.5T; 2D CINE steady state free precession (SSF)P imaging, T 2 -mapping, pre- and postgadolinium contrast T 1 -mapping, and tissue-phase mapping (TPM). Assessment: Quantification of myocardial T 2 (as a measure of edema), pre- and post-Gd T 1 (allowing calculation of extracellular volume (ECV) to estimate interstitial expansion), and TPM-based assessment of peak regional left ventricular (LV) velocities, dyssynchrony, and twist. Statistical Tests: Comparisons between transplant recipients and controls were performed using independent samples t-tests. Relationships between structural (T 2 , T 1 , ECV) and functional measures (myocardial velocities, dyssynchrony, twist) were assessed using Pearson correlation analysis. Results: T 2 and T 1 were significantly elevated in transplant recipients compared to controls (global T 2 : 50.5 ± 3.4 msec vs. 45.2 ± 2.3 msec, P < 0.01; global T 1 : 1037.8 ± 48.0 msec vs. 993.8 ± 34.1 msec, P < 0.01). Systolic longitudinal function was impaired in transplant recipients compared to controls (reduced peak systolic longitudinal velocities, 2.9 ± 1.1 cm/s vs. 5.1 ± 1.2 cm/s, P < 0.01; elevated systolic longitudinal dyssynchrony, 60.2 ± 30.2 msec vs. 32.1 ± 25.1 msec, P < 0.01). Correlation analysis revealed a significant positive relationship between T 2 and ECV (r = 0.45,P < 0.01). In addition, peak systolic longitudinal velocities demonstrated a significant inverse relationship with T 2 (global r = –0.29, P = 0.02), and systolic radial dyssynchrony was positively associated with peak T 2 and peak T 1 (r = 0.26,P = 0.04; r = 0.27,P = 0.03). Data Conclusion: MR techniques are sensitive to structural and functional differences in transplant recipients compared to controls. Structural (T 2 , T 1 ) and functional (peak myocardial velocities, dyssynchrony) measures were significantly associated, suggesting a structure–function relationship of cardiac abnormalities following heart transplant. Level of Evidence: 2. Technical Efficacy Stage: 2. J. Magn. Reson. Imaging 2019;49:678–687.",
keywords = "T -mapping, T -mapping, cardiac, heart transplantation, tissue phase mapping",
author = "Dolan, {Ryan S.} and Rahsepar, {Amir A.} and Julie Blaisdell and Kai Lin and Kenichiro Suwa and Kambiz Ghafourian and Wilcox, {Jane E} and Khan, {Sadiya Sana} and Vorovich, {Esther Elizabeth} and Rich, {Jonathan D} and Anderson, {Allen Sawyer} and Yancy, {Clyde W} and Collins, {Jeremy D} and Michael Markl and James Carr",
year = "2019",
month = "3",
day = "1",
doi = "10.1002/jmri.26275",
language = "English (US)",
volume = "49",
pages = "678--687",
journal = "Journal of Magnetic Resonance Imaging",
issn = "1053-1807",
publisher = "John Wiley and Sons Inc.",
number = "3",

}

TY - JOUR

T1 - Cardiac Structure–Function MRI in Patients After Heart Transplantation

AU - Dolan, Ryan S.

AU - Rahsepar, Amir A.

AU - Blaisdell, Julie

AU - Lin, Kai

AU - Suwa, Kenichiro

AU - Ghafourian, Kambiz

AU - Wilcox, Jane E

AU - Khan, Sadiya Sana

AU - Vorovich, Esther Elizabeth

AU - Rich, Jonathan D

AU - Anderson, Allen Sawyer

AU - Yancy, Clyde W

AU - Collins, Jeremy D

AU - Markl, Michael

AU - Carr, James

PY - 2019/3/1

Y1 - 2019/3/1

N2 - Background: Following heart transplantation (Tx), recipients are closely monitored using endomyocardial biopsy, which is limited by cost and invasiveness, and echocardiography, which is limited regarding detailed structural and functional evaluation. Purpose: To test the feasibility of comprehensive structure–function cardiac MRI as a noninvasive modality to assess changes in myocardial structure and function. Study Type: Prospective. Subjects: MR was performed in 61 heart transplant recipients (age 47.9 ± 16.3 years, 39% female) and 14 age-matched healthy controls (age 47.7 ± 16.7 years, 36% female). Field Strength/Sequence: 1.5T; 2D CINE steady state free precession (SSF)P imaging, T 2 -mapping, pre- and postgadolinium contrast T 1 -mapping, and tissue-phase mapping (TPM). Assessment: Quantification of myocardial T 2 (as a measure of edema), pre- and post-Gd T 1 (allowing calculation of extracellular volume (ECV) to estimate interstitial expansion), and TPM-based assessment of peak regional left ventricular (LV) velocities, dyssynchrony, and twist. Statistical Tests: Comparisons between transplant recipients and controls were performed using independent samples t-tests. Relationships between structural (T 2 , T 1 , ECV) and functional measures (myocardial velocities, dyssynchrony, twist) were assessed using Pearson correlation analysis. Results: T 2 and T 1 were significantly elevated in transplant recipients compared to controls (global T 2 : 50.5 ± 3.4 msec vs. 45.2 ± 2.3 msec, P < 0.01; global T 1 : 1037.8 ± 48.0 msec vs. 993.8 ± 34.1 msec, P < 0.01). Systolic longitudinal function was impaired in transplant recipients compared to controls (reduced peak systolic longitudinal velocities, 2.9 ± 1.1 cm/s vs. 5.1 ± 1.2 cm/s, P < 0.01; elevated systolic longitudinal dyssynchrony, 60.2 ± 30.2 msec vs. 32.1 ± 25.1 msec, P < 0.01). Correlation analysis revealed a significant positive relationship between T 2 and ECV (r = 0.45,P < 0.01). In addition, peak systolic longitudinal velocities demonstrated a significant inverse relationship with T 2 (global r = –0.29, P = 0.02), and systolic radial dyssynchrony was positively associated with peak T 2 and peak T 1 (r = 0.26,P = 0.04; r = 0.27,P = 0.03). Data Conclusion: MR techniques are sensitive to structural and functional differences in transplant recipients compared to controls. Structural (T 2 , T 1 ) and functional (peak myocardial velocities, dyssynchrony) measures were significantly associated, suggesting a structure–function relationship of cardiac abnormalities following heart transplant. Level of Evidence: 2. Technical Efficacy Stage: 2. J. Magn. Reson. Imaging 2019;49:678–687.

AB - Background: Following heart transplantation (Tx), recipients are closely monitored using endomyocardial biopsy, which is limited by cost and invasiveness, and echocardiography, which is limited regarding detailed structural and functional evaluation. Purpose: To test the feasibility of comprehensive structure–function cardiac MRI as a noninvasive modality to assess changes in myocardial structure and function. Study Type: Prospective. Subjects: MR was performed in 61 heart transplant recipients (age 47.9 ± 16.3 years, 39% female) and 14 age-matched healthy controls (age 47.7 ± 16.7 years, 36% female). Field Strength/Sequence: 1.5T; 2D CINE steady state free precession (SSF)P imaging, T 2 -mapping, pre- and postgadolinium contrast T 1 -mapping, and tissue-phase mapping (TPM). Assessment: Quantification of myocardial T 2 (as a measure of edema), pre- and post-Gd T 1 (allowing calculation of extracellular volume (ECV) to estimate interstitial expansion), and TPM-based assessment of peak regional left ventricular (LV) velocities, dyssynchrony, and twist. Statistical Tests: Comparisons between transplant recipients and controls were performed using independent samples t-tests. Relationships between structural (T 2 , T 1 , ECV) and functional measures (myocardial velocities, dyssynchrony, twist) were assessed using Pearson correlation analysis. Results: T 2 and T 1 were significantly elevated in transplant recipients compared to controls (global T 2 : 50.5 ± 3.4 msec vs. 45.2 ± 2.3 msec, P < 0.01; global T 1 : 1037.8 ± 48.0 msec vs. 993.8 ± 34.1 msec, P < 0.01). Systolic longitudinal function was impaired in transplant recipients compared to controls (reduced peak systolic longitudinal velocities, 2.9 ± 1.1 cm/s vs. 5.1 ± 1.2 cm/s, P < 0.01; elevated systolic longitudinal dyssynchrony, 60.2 ± 30.2 msec vs. 32.1 ± 25.1 msec, P < 0.01). Correlation analysis revealed a significant positive relationship between T 2 and ECV (r = 0.45,P < 0.01). In addition, peak systolic longitudinal velocities demonstrated a significant inverse relationship with T 2 (global r = –0.29, P = 0.02), and systolic radial dyssynchrony was positively associated with peak T 2 and peak T 1 (r = 0.26,P = 0.04; r = 0.27,P = 0.03). Data Conclusion: MR techniques are sensitive to structural and functional differences in transplant recipients compared to controls. Structural (T 2 , T 1 ) and functional (peak myocardial velocities, dyssynchrony) measures were significantly associated, suggesting a structure–function relationship of cardiac abnormalities following heart transplant. Level of Evidence: 2. Technical Efficacy Stage: 2. J. Magn. Reson. Imaging 2019;49:678–687.

KW - T -mapping

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KW - tissue phase mapping

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