The challenge to detect heart transplant rejection and transplant vasculopathy non-invasively - a pilot study.
BACKGROUND
Cardiac allograft rejection and vasculopathy are the main factors limiting long-term survival after heart transplantation.In this pilot study we investigated whether non-invasive methods are beneficial to detect cardiac allograft rejection (Grade 03 R) and cardiac allograft vasculopathy. Thus we compared multi-slice computed tomography and magnetic resonance imaging with invasive methods like coronary angiography and left endomyocardial biopsy.


METHODS
10 asymptomatic long-term survivors after heart transplantation (8 male, 2 female, mean age 52.1 +/- 12 years, 73 +/- 11 months after transplantation) were included. In a blinded fashion, coronary angiography and multi-slice computed tomography and ventricular endomyocardial biopsy and magnetic resonance imaging were compared against each other.


RESULTS
Cardiac allograft vasculopathy and atherosclerosis were correctly detected by multi-slice computed tomography and coronary angiography with positive correlation (r = 1). Late contrast enchancement found by magnetic resonance imaging correlated positively (r = 0.92, r2 = 0.85, p < 0.05) with the histological diagnosis of transplant rejection revealed by myocardial biopsy. None of the examined endomyocardial specimen revealed cardiac allograft rejection greater than Grade 1 R.


CONCLUSIONS
A combined non-invasive approach using multi-slice computed tomography and magnetic resonance imaging may help to assess cardiac allograft vasculopathy and cardiac allograft rejection after heart transplantation before applying more invasive methods.
Usta
Engin
E
Department of Thoracic-, Cardiac- and Vascular Surgery, Tübingen University Hospital, Germany. engin.usta@med.uni-tuebingen.de
Burgstahler
Christof
C
Aebert
Hermann
H
Schroeder
Stephen
S
Helber
Uwe
U
Kopp
Andreas F
AF
Ziemer
Gerhard
G
D000328:Adult; D000368:Aged; D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000175:diagnosis* / Q000473:pathology / Q000517:prevention & control; D016027:Heart Transplantation / Q000009:adverse effects / Q000473:pathology; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology; D010865:Pilot Projects; D017741:Survivors; D036542:Tomography, Spiral Computed / Q000379:methods; D016896:Treatment Outcome
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