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Multiparametric cardiovascular magnetic resonance assessment of cardiac allograft vasculopathy.

Abstract：

OBJECTIVES:This study sought to evaluate the diagnostic performance of multiparametric cardiovascular magnetic resonance (CMR) for detecting cardiac allograft vasculopathy (CAV) using contemporary invasive epicardial artery and microvascular assessment techniques as reference standards, and to compare the performance of CMR with that of angiography. BACKGROUND:CAV continues to limit the long-term survival of heart transplant recipients. Coronary angiography has a Class I recommendation for CAV surveillance and annual or biannual surveillance angiography is performed routinely in most centers. METHODS:All transplant recipients referred for surveillance angiography at a single UK center over a 2-year period were prospectively screened for study eligibility. Patients prospectively underwent coronary angiography followed by coronary intravascular ultrasound, fractional flow reserve, and index of microcirculatory resistance. Within 1 month, patients underwent multiparametric CMR, including assessment of regional and global ventricular function, absolute myocardial blood flow quantification, and myocardial tissue characterization. In addition, 10 healthy volunteers underwent CMR. RESULTS:Forty-eight patients were recruited, median 7.1 years (interquartile range: 4.6 to 10.3 years) since transplantation. The CMR myocardial perfusion reserve was the only independent predictor of both epicardial (β = -0.57, p < 0.001) and microvascular disease (β = -0.60, p < 0.001) on stepwise multivariable regression. The CMR myocardial perfusion reserve significantly outperformed angiography for detecting moderate CAV (area under the curve, 0.89 [95% confidence interval (CI): 0.79 to 1.00] vs. 0.59 [95% CI: 0.42 to 0.77], p = 0.01) and severe CAV (area under the curve, 0.88 [95% CI: 0.78 to 0.98] vs. 0.67 [95% CI: 0.52 to 0.82], p = 0.05). CONCLUSIONS:CAV, including epicardial and microvascular components, can be detected more accurately using noninvasive CMR-based absolute myocardial blood flow assessment than with invasive coronary angiography, the current clinical surveillance technique.

journal_name

J Am Coll Cardiol

journal_title

Journal of the American College of Cardiology

authors

Miller CA,Sarma J,Naish JH,Yonan N,Williams SG,Shaw SM,Clark D,Pearce K,Stout M,Potluri R,Borg A,Coutts G,Chowdhary S,McCann GP,Parker GJ,Ray SG,Schmitt M

doi

10.1016/j.jacc.2013.07.119

subject

Has Abstract

pub_date

2014-03-04 00:00:00

pages

799-808

issue

eissn

0735-1097

issn

1558-3597

pii

S0735-1097(13)06377-8

journal_volume

pub_type

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Multiparametric cardiovascular magnetic resonance assessment of cardiac allograft vasculopathy.