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 S.
AU - Vorovich, Esther E.
AU - Rich, Jonathan D.
AU - Anderson, Allen S.
AU - Yancy, Clyde W.
AU - Collins, Jeremy D.
AU - Markl, Michael
AU - Carr, James C.
N1 - Funding Information:
Grant Support: National Institutes of Health, (NIH); contract grant numbers: NHLBI grant R01 HL117888.
Publisher Copyright:
© 2018 International Society for Magnetic Resonance in Medicine
PY - 2019/3
Y1 - 2019/3
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
KW - cardiac
KW - heart transplantation
KW - tissue phase mapping
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U2 - 10.1002/jmri.26275
DO - 10.1002/jmri.26275
M3 - Article
C2 - 30142237
AN - SCOPUS:85052432010
SN - 1053-1807
VL - 49
SP - 678
EP - 687
JO - Journal of Magnetic Resonance Imaging
JF - Journal of Magnetic Resonance Imaging
IS - 3
ER -