Multiparametric cardiovascular magnetic resonance surveillance of acute cardiac allograft rejection and characterisation of transplantation-associated myocardial injury: a pilot study.
Multiparametric cardiovascular magnetic resonance surveillance of acute cardiac allograft rejection and characterisation of transplantation-associated myocardial injury: a pilot study.
复制标题
DOI：
10.1186/s12968-014-0052-6
复制
发表时间：
2014-07-20
期刊：
影响因子：
--
通讯作者：
Schmitt M
中科院分区：
文献类型：
--
作者：
Miller CA;Naish JH;Shaw SM;Yonan N;Williams SG;Clark D;Bishop PW;Ainslie MP;Borg A;Coutts G;Parker GJ;Ray SG;Schmitt M
在最近接受心脏移植的患者中进行连续监测肌内膜活检，以便在症状发生前检测急性心脏同种异体移植物排斥反应（ACAR），然而活检过程与许多限制相关。本研究旨在前瞻性和纵向评价多参数心血管磁共振（CMR）在移植后早期检测和监测ACAR的性能，并描述移植后移植物恢复的特征。所有在英国一个中心接受心脏移植超过25个月的患者都在移植后一个月内接受了治疗。在4个不同的时间点（移植后6周、10周、15周和20周），在活检当天前瞻性地进行多参数CMR。CMR包括整体和局部心室功能评估、心肌组织定征（T1标测、T2标测、细胞外容积、LGE）和逐像素绝对心肌血流定量。CMR参数与活检结果进行了比较。作为标准，2 R级或更高ACAR被认为是显著的。对22例患者进行了88次CMR匹配活检。5例患者的8例（9%）活检显示显著ACAR。显著ACAR与环向应变降低相关（−12.7 ± 2.5% vs. -13.7 ± 3.6%，p = 0.047），但两组之间存在相当大的重叠。虽然在ACAR和拟定的CMR水肿标志物之间观察到趋势，特别是在调整原发性移植物功能障碍后，差异不显著。在研究期间，移植物结构和收缩性、水肿和微血管功能的标志物有显著改善，尽管很少参数正常化。这项研究提供了新的见解与移植相关的心肌损伤，其恢复，但多参数CMR不能准确地检测ACAR在移植后的早期阶段。
Serial surveillance endomyocardial biopsies are performed in patients who have recently undergone heart transplantation in order to detect acute cardiac allograft rejection (ACAR) before symptoms occur, however the biopsy process is associated with a number of limitations. This study aimed to prospectively and longitudinally evaluate the performance of multiparametric cardiovascular magnetic resonance (CMR) for detecting and monitoring ACAR in the early phase post-transplant, and characterize graft recovery following transplantation. All patients receiving a heart transplant at a single UK centre over a period of 25 months were approached within one month of transplantation. Multiparametric CMR was prospectively performed on the same day as biopsy on four separate occasions (6 weeks, 10 weeks, 15 weeks and 20 weeks post-transplant). CMR included assessment of global and regional ventricular function, myocardial tissue characterization (T1 mapping, T2 mapping, extracellular volume, LGE) and pixel-wise absolute myocardial blood flow quantification. CMR parameters were compared with biopsy findings. As is standard, grade 2R or higher ACAR was considered significant. 88 CMR-matched biopsies were performed in 22 patients. Eight (9%) biopsies in 5 patients demonstrated significant ACAR. Significant ACAR was associated with a reduction in circumferential strain (−12.7 ± 2.5% vs. -13.7 ± 3.6%, p = 0.047) but there was considerable overlap between groups. Whilst trends were observed between ACAR and proposed CMR markers of oedema, particularly after adjusting for primary graft dysfunction, differences were not significant. Significant improvements were seen in markers of graft structure and contractility, oedema and microvascular function over the period studied, although few parameters normalised. This study provides novel insight into the myocardial injury associated with transplantation, and its recovery, however multiparametric CMR was not able to accurately detect ACAR during the early phase post-transplantation.
登录
查看更多内容
DOI：
10.1161/circimaging.111.967836
发表时间：
2012-01
期刊：
Circulation. Cardiovascular imaging
影响因子：
--
作者：
Thavendiranathan P;Walls M;Giri S;Verhaert D;Rajagopalan S;Moore S;Simonetti OP;Raman SV
通讯作者：
Raman SV
影响因子：
7.5
作者：
Miller, Christopher A.;Naish, Josephine H.;Schmitt, Matthias
通讯作者：
Schmitt, Matthias
影响因子：
4.4
作者：
Miller, Christopher A.;Borg, Alex;Schmitt, Matthias
通讯作者：
Schmitt, Matthias
影响因子：
8.9
作者：
Stewart, S;Winters, GL;Billingham, ME
通讯作者：
Billingham, ME
影响因子：
3.5
作者：
Biglands, J.;Magee, D.;Radjenovic, A.
通讯作者：
Radjenovic, A.