Late gadolinium enhancement assessed by cardiac magnetic resonance imaging in heart transplant recipients with different stages of cardiac allograft vasculopathy

Abstract

AIMS: Cardiac allograft vasculopathy (CAV), which limits long-term survival after heart transplantation (HTX), is usually evaluated by coronary angiography (CA). Late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) is a non-invasive technique that can detect CAV-related myocardial infarctions. We aimed to investigate the presence of LGE infarct-typical patterns in a large sample of HTX recipients and to correlate these findings with the severity of CAV assessed by CA. METHODS AND RESULTS: LGE-CMR was performed in 132 HTX patients on a 1.5-T MRI scanner (Philips, Best, the Netherlands). Infarct-typical LGE areas were identified as bright lesions with subendocardial involvement. Infarct-atypical LGE was classified as follows: (i) right ventricle (RV) insertion, (ii) intramural, (iii) epicardial, and (iv) diffuse. CA was performed for the assessment of CAV (CAV0 = no lesion, CAV1 = mild lesions, CAV2 = moderate lesions, CAV3 = severe lesions, or mild/moderate lesions with allograft dysfunction). Infarct-typical LGE patterns were detected in 29 (22%) patients distributed in all groups and they were already present in nearly every fifth CAV0 patient, increasing significantly among CAV groups (CAV0 = 19%, CAV1 = 10%, CAV2 = 36%, and CAV3 = 71%; P < 0.01). CONCLUSION: LGE-CMR was useful to identify myocardial scar possibly related to early CAV in a significant proportion of HTX recipients, otherwise classified as low-risk patients based on CA. Therefore, LGE-CMR could be helpful to intensify CAV monitoring, medical therapy, and clinical risk stratification.