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Prevalence of different forms of infarct-atypical late gadolinium enhancement in patients early and late after heart transplantation

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Abstract

Background

Late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) enables high-resolution myocardial tissue characterization, showing the results of different injuries, especially in the early period after heart transplantation (HTX).

Objectives

We sought to apply LGE-CMR to investigate the prevalence and patterns of infarct-atypical myocardial involvement and associated mechanisms in patients early and late after HTX.

Methods

LGE-CMR was performed on a 1.5-T MRI scanner (Philips, Best, the Netherlands) in 89 patients: group 1 (48 patients) less than 2.5 years after operation (1.2 ± 0.5 years) and group 2 (41 patients) later this period (8.2 ± 4.2 years). Following LGE-CMR, the presence, distribution, patterns of infarct-atypical LGE and possible associated mechanisms were assessed.

Results

71 % of group 1 patients (34/48) showed infarct-atypical LGE whereas 57 % of group 2 patients (22/41) were affected (p = 0.25). Fewer segments/patients were involved later after HTX (1.6 ± 2.0 vs. 2.9 ± 3.1 segments/patient; p = 0.03), but only diffuse LGE-CMR pattern decreased significantly (11.5 % of affected segments in group 1 vs. 6.5 % in group 2; p < 0.001). Group 2 had lower ischemic time (181 ± 53 vs. 208 ± 61 min; p = 0.03), the donors were younger (33 ± 13 vs. 41 ± 13 years; p = 0.01) and fewer donors were Toxoplasma gondii seropositive (4 vs. 22pts; p < 0.001).

Conclusion

Infarct-atypical LGE was found in a significant number of patients early post-HTX, however, fewer patients and myocardial segments per patient were affected later after HTX. Many potential factors seem to be involved, but the exact mechanisms are still unclear. Future studies are necessary to test prognostic implications associated with LGE-CMR patterns.

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Abbreviations

ACR:

Acute cardiac rejection

CAV:

Cardiac allograft vasculopathy

CMR:

Cardiac magnetic resonance

EMB:

Endomyocardial biopsy

HTX:

Heart transplantation

LGE:

Late gadolinium enhancement

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Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

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Authors and Affiliations

  1. Department of Cardiology, Angiology und Pneumology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany

    M. F. Braggion-Santos, F. Andre, D. Lossnitzer, E. Hofmann, J. Simpfendörfer, A. Dösch, H. A. Katus & H. Steen

  2. School of Medicine of Ribeirao Preto, University of Sao Paulo, São Paulo, Brazil

    M. F. Braggion-Santos

  3. Department of Cardiology, Lake Constance Heart Center, Kreuzlingen, Switzerland

    H. Steen

  4. Department of Cardiology, Lake Constance Heart Center, Constance, Germany

    H. Steen

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  1. M. F. Braggion-Santos
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  2. F. Andre
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  3. D. Lossnitzer
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  4. E. Hofmann
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  5. J. Simpfendörfer
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  6. A. Dösch
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  7. H. A. Katus
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  8. H. Steen
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Correspondence to H. Steen.

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Braggion-Santos, M.F., Andre, F., Lossnitzer, D. et al. Prevalence of different forms of infarct-atypical late gadolinium enhancement in patients early and late after heart transplantation. Clin Res Cardiol 103, 57–63 (2014). https://doi.org/10.1007/s00392-013-0623-9

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  • DOI: https://doi.org/10.1007/s00392-013-0623-9

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