Comprehensive Bio-Imaging Using Myocardial Perfusion Reserve Index During Cardiac Magnetic Resonance Imaging and High-Sensitive Troponin T for the Prediction of Outcomes in Heart Transplant Recipients
Comprehensive Bio-Imaging Using Myocardial Perfusion Reserve Index During Cardiac Magnetic Resonance Imaging and High-Sensitive Troponin T for the Prediction of Outcomes in Heart Transplant Recipients
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DOI：
10.1111/ajt.12924
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发表时间：
2014-11-01
影响因子：
8.8
通讯作者：
Korosoglou, G.
中科院分区：
文献类型：
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作者：
Hofmann, N. P.;Steuer, C.;Korosoglou, G.
本研究旨在探讨心脏磁共振（CMR）定量心肌灌注储备指数（MPRI）和高敏肌钙蛋白T（hsTnT）对心脏移植（HT）受者移植心脏血管病变（CAV）和心脏预后的预测能力。108例HT受者（器官年龄4.14.7岁，25例（23%）合并糖尿病）行心导管检查，按国际心肺移植学会（ISHLT）标准进行CAV分级，测定MPRI、晚期钆增强（LGE）和hsTnT值。前瞻性收集结局数据，包括心源性死亡和紧急血运重建（硬心脏事件）和血运重建手术。在4.2 +/- 1.4年的随访期间，7例患者发生了严重心脏事件，11例患者接受了择期血运重建术。多因素分析显示，hsTnT和MPRI均能独立预测心脏事件，超过ISHLT标准的LGE和CAV值。此外，hsTnT和MPRI具有互补价值。因此，高hsTnT和低MPRI的患者显示出最高的心脏事件率（年事件率=14.5%），而低hsTnT和高MPRI的患者表现出良好的结局（年事件率=0%）。总之，使用hsTnT作为心肌微损伤的标志物和CMR作为微血管完整性和LGE心肌损伤的标志物的综合生物成像可能有助于HT接受者的个性化风险分层。高敏肌钙蛋白T是心血管风险的既定标志物，血管扩张剂心脏磁共振成像中定量心肌灌注储备对慢性移植物的预测具有互补价值心脏移植受者的血管病变进展和临床结局。
We sought to determine the ability of quantitative myocardial perfusion reserve index (MPRI) by cardiac magnetic resonance (CMR) and high-sensitive troponin T (hsTnT) for the prediction of cardiac allograft vasculopathy (CAV) and cardiac outcomes in heart transplant (HT) recipients. In 108 consecutive HT recipients (organ age 4.14.7years, 25 [23%] with diabetes mellitus) who underwent cardiac catheterization, CAV grade by International Society for Heart & Lung Transplantation (ISHLT) criteria, MPRI, late gadolinium enhancement (LGE) and hsTnT values were obtained. Outcome data including cardiac death and urgent revascularization (hard cardiac events) and revascularization procedures were prospectively collected. During a follow-up duration of 4.2 +/- 1.4 years, seven patients experienced hard cardiac events and 11 patients underwent elective revascularization procedures. By multivariable analysis, hsTnT and MPRI both independently predicted cardiac events, surpassing the value of LGE and CAV by ISHLT criteria. Furthermore, hsTnT and MPRI provided complementary value. Thus, patients with high hsTnT and low MPRI showed the highest rates of cardiac events (annual event rate=14.5%), while those with low hsTnT and high MPRI exhibited excellent outcomes (annual event rate=0%). In conclusion, comprehensive bio-imaging using hsTnT, as a marker of myocardial microinjury, and CMR, as a marker of microvascular integrity and myocardial damage by LGE, may aid personalized risk-stratification in HT recipients.The high-sensitive troponin T, an established marker of cardiovascular risk, and quantitative myocardial perfusion reserve during vasodilator cardiac magnetic resonance exhibit complementary value for the prediction of chronic allograft vasculopathy progression and clinical outcomes in cardiac transplant recipients.