Multiparametric Cardiovascular Magnetic Resonance Assessment of Cardiac Allograft Vasculopathy
Multiparametric Cardiovascular Magnetic Resonance Assessment of Cardiac Allograft Vasculopathy
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DOI：
10.1016/j.jacc.2013.07.119
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发表时间：
2014-03-04
影响因子：
24
通讯作者：
Schmitt, Matthias
中科院分区：
文献类型：
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作者：
Miller, Christopher A.;Sarma, Jaydeep;Schmitt, Matthias
目的 本研究旨在以当代侵入性心外膜动脉和微血管评估技术为参考标准，评估多参数心血管磁共振 (CMR) 对心脏同种异体移植血管病变 (CAV) 的诊断性能，并将 CMR 的性能与血管造影的性能进行比较。 背景 CAV 继续限制心脏移植受者的长期生存。冠状动脉造影对于 CAV 监测具有 I 类推荐，大多数中心每年或每两年进行一次监测血管造影。 方法 对所有在 2 年期间在单一英国中心转诊进行监测血管造影的移植受者进行前瞻性筛选研究资格。患者前瞻性地接受了冠状动脉造影，然后进行冠状动脉血管内超声、血流储备分数和微循环阻力指数。 1 个月内，患者接受了多参数 CMR，包括局部和整体心室功能评估、绝对心肌血流定量和心肌组织表征。此外，10 名健康志愿者接受了 CMR。 结果 招募了 48 名患者，移植后中位时间为 7.1 年（四分位距：4.6 至 10.3 年）。在逐步多变量回归中，CMR 心肌灌注储备是心外膜疾病（β = -0.57，p < 0.001）和微血管疾病（β = -0.60，p < 0.001）的唯一独立预测因子。在检测中度 CAV（曲线下面积，0.89 [95% CI：0.79 至 1.00] 与 0.59 [95% CI：0.42 至 0.77]，p = 0.01）和重度 CAV（曲线下面积，0.88 [95% CI：0.78 至 1.00]）方面，CMR 心肌灌注储备显着优于血管造影。 0.98] vs. 0.67 [95% CI：0.52 至 0.82]，p = 0.05）。结论 使用基于 CMR 的无创绝对心肌血流评估可以比当前临床监测技术有创冠状动脉造影更准确地检测 CAV，包括心外膜和微血管成分。 (C) 2014 年，美国心脏病学会基金会
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 (beta = -0.57, p < 0.001) and microvascular disease (beta = -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. (C) 2014 by the American College of Cardiology Foundation