Cardiac magnetic resonance imaging in detection of progressive graft dysfunction in pediatric heart transplantation.
Cardiac magnetic resonance imaging in detection of progressive graft dysfunction in pediatric heart transplantation.
复制标题
心脏磁共振成像检测儿童心脏移植中进行性移植物功能障碍。
DOI：
10.1111/petr.14652
复制
发表时间：
2024
影响因子：
1.3
通讯作者：
Husain,Nazia
中科院分区：
文献类型：
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作者：
Watanabe,Kae;Arva,NicoletaC;Robinson,JoshuaD;Rigsby,Cynthia;Markl,Michael;Sojka,Melanie;Tannous,Paul;Arzu,Jennifer;Husain,Nazia
儿童心脏移植(PHT)中慢性移植物衰竭(CGF)是多因素的，心内膜心肌活检(EMB)可表现为纤维化和微血管病变(MVD)。目前尚无最佳的CGF监测方法。我们评估心脏磁共振成像(CMR)与CGF的历史/EMB相关性之间的关系，以评估CMR作为一种监测方法的实用性。方法对2015年9月至2022年1月接受全面CMR的PHT患者进行回顾性分析。对6个 月内的EMB进行纤维化分级(0-5级)和微血管密度(每视野内有狭窄管壁增厚的毛细血管数目)。结果47例门静脉高压症患者中位年龄为15.7 年(11.6，19.3)，移植后中位年龄为6.4 年(4.1，11.0)。移植心脏血管病变(CAV)11/44(22.0%)，既往排斥反应14/41(34.2%)。CAV与更高的整体T2(49.0vs.47.0 ms；p= 0.038)和T2峰值(57.0vs.53.0 ms；p= 0.013)有关。既往排斥反应与较高的整体T2(49.0vs.47.0 ms；p= 0.007)和T2峰值(57.0vs.53.0 ms；p= 0.03)以及全球细胞外容量(31.0vs.26.3%；p= 0.03)有关。EMB上较高的纤维化积分与较小的指数化左室质量(Rho = −0.34；p= 0.019)和较大程度的微血管病变(Rho = −0.35；p= 0.017)相关。CMR在CGF的筛查中具有潜在的应用价值。
BackgroundChronic graft failure (CGF) in pediatric heart transplant (PHT) is multifactorial and may present with findings of fibrosis and microvessel disease (MVD) on endomyocardial biopsy (EMB). There is no optimal CGF surveillance method. We evaluated associations between cardiac magnetic resonance imaging (CMR) and historical/EMB correlates of CGF to assess CMR's utility as a surveillance method.MethodsRetrospective analysis of PHT undergoing comprehensive CMR between September 2015 and January 2022 was performed. EMB within 6 months was graded for fibrosis (scale 0–5) and MVD (number of capillaries with stenotic wall thickening per field of view). Correlation analysis and logistic regression were performed.ResultsForty‐seven PHT with median age at CMR of 15.7 years (11.6, 19.3) and time from transplant of 6.4 years (4.1, 11.0) were studied. Cardiac allograft vasculopathy (CAV) was present in 11/44 (22.0%) and historical rejection in 14/41 (34.2%). CAV was associated with higher global T2 (49.0 vs. 47.0 ms;p= 0.038) and peak T2 (57.0 vs. 53.0 ms;p= 0.013) on CMR. Historical rejection was associated with higher global T2 (49.0 vs. 47.0 ms;p= 0.007) and peak T2 (57.0 vs. 53.0 ms;p= 0.03) as well as global extracellular volume (31.0 vs. 26.3%;p= 0.03). Higher fibrosis score on EMB correlated with smaller indexed left ventricular mass (rho = −0.34;p= 0.019) and greater degree of MVD with lower indexed left ventricular end‐diastolic volume (rho = −0.35;p= 0.017).ConclusionAdverse ventricular remodeling and abnormal myocardial characteristics on CMR are present in PHT with CAV, historical rejection, as well as greater fibrosis and MVD on EMB. CMR has the potential use for screening of CGF.