title: Allograft morphology and function in heart transplant recipients surviving more than 15 years by magnetic resonance imaging and dual-source computed tomography.
abstract: OBJECTIVE
  Cardiac allograft vasculopathy and late graft failure are the main limiting factors of long-term success of heart transplantation, and little is known about graft function in the long-term survivors. The aim of this study was to assess the ventricular function and the allograft vasculopathy in long-term survivors (>15 years) with the cardiac magnetic resonance imaging (MRI) and dual-source computed tomography (DSCT) coronary angiogram.
  
  
  METHODS
  In our database, 34 cardiac recipients have more than 15 years of follow-up and were evaluated for this study; 22 (65%) of them were enrolled. Mean age at transplant was 46 ± 13.5 years, mean donor age was 28.5 ± 10.1 years, and mean graft ischemic time was 189 ± 58 min. Mean follow-up was 18.5 ± 2.4 years (range 15-22). All patients underwent cardiac MRI and DSCT.
  
  
  RESULTS
  Mean left ventricular (LV) volumes indexed to the body surface area (BSA) were within normal range: the end-diastolic volume/BSA was 61 ± 16 ml m(-2), end-systolic volume/BSA was 22 ± 15 ml m(-2), stroke volume/BSA was 38 ± 6 ml m(-2), LV mass/BSA: 72 ± 18 g m(-2), and mean ejection fraction (EF) was 0.59 ± 0.08. Two patients (9%) showed a global cardiac hypokinesia and two other patients (9%) showed akinesia of one segment. At DSCT, 41% of patients had a strictly normal coronary angiogram, 41% had wall thickening and 18% presented a least one >60% stenosis.
  
  
  CONCLUSIONS
  Cardiac MRI and DSCT coronary angiogram revealed a normal graft function and morphology after more than 15 years of transplantation. However, a certain number of patients have significant cardiac allograft vasculopathy and another consistent group has initial disease. These patients deserve further follow-up and tailoring of the immunosuppressive regimen.
authors: Department of Cardiovascular Surgery, Clínica Universidad de Navarra, Avenida Pio XII 36, 31008 Pamplona, Spain. smastrobuoni@ottawaheart.ca
authors: Stefano
authors: S
authors: Mastrobuoni
authors: Angelo Maria
authors: AM
authors: Dell'aquila
authors: Maria
authors: M
authors: Arraiza
authors: Gorka
authors: G
authors: Bastarrika
authors: Pedro Maria
authors: PM
authors: Azcarate
authors: Jesus
authors: J
authors: Pueyo
authors: Gregorio
authors: G
authors: Rabago
authors: Jesus
authors: J
authors: Herreros
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D017023:Coronary Angiography / Q000379:methods; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000209:etiology; D005500:Follow-Up Studies; D006085:Graft Survival; D016027:Heart Transplantation / Q000009:adverse effects* / Q000000981:diagnostic imaging / Q000473:pathology / Q000502:physiology; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology*; D013318:Stroke Volume / Q000502:physiology; D017741:Survivors; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult