Semi-quantitative myocardial perfusion MRI in heart transplant recipients at rest: repeatability in healthy controls and assessment of cardiac allograft vasculopathy

Background: Cardiac Allograft Vasculopathy (CAV) is a major cause of chronic cardiac allograft failure. Invasive coronary angiography (ICA) and intravascular ultrasound (IVUS) are the current diagnostic methods. Myocardial perfusion MRI has become a promising non-invasive method to evaluate myocardial ischemia, but has not been thoroughly validated in CAV. Our objective was to assess the repeatability of myocardial rest-perfusion MRI in healthy volunteers and its feasibility in detecting CAV in transplant patients (Tx). Methods: Twelve healthy volunteers and twenty transplant patients beyond the first year post- transplant underwent cardiac MRI at 1.5 T at rest including first-pass perfusion imaging in short axis (base, mid, apex) after injection of gadolinium. Volunteers underwent repeated cardiac MRI on different days (interval = 15.6 ± 2.4 days) to assess repeatability. Data analysis included semi-automatic contouring of endocardial and epicardial borders of the left ventricle (LV) and quantification of peak perfusion, time-to-peak (TTP) perfusion, and upslope of the perfusion curve. Results: Between scans and re-scans in healthy volunteers, peak signal intensity, slope, and TTP demonstrated moderate agreement (ICC = 0.53, 0.48, and 0.59, respectively; all, p < .001). Peak signal intensity, slope, and TTP were moderately variable with COV values of 23%, 42%, and 35%, respectively. Peak perfusion was significantly reduced in CAV positive (n = 9 Tx patients) compared to CAV negative (n = 11 Tx patients) groups (90.7 ± 27.0 vs 139.5 ± 30.2, p < .001). Conclusion: Cardiac MRI is a moderately repeatable method for the semi-quantitative assessment of first-pass myocardial perfusion at rest. Semi-quantitative surrogate markers of LV perfusion could play a role in CAV detection.