title: Multiparametric cardiovascular magnetic resonance assessment of cardiac allograft vasculopathy.
abstract: OBJECTIVE
  This study sought to evaluate the diagnostic performance of multiparametric cardiovascular magnetic resonance (CMR) for detecting cardiac allograft vasculopathy (CAV) using contemporary invasive epicardial artery and microvascular assessment techniques as reference standards, and to compare the performance of CMR with that of angiography.
  
  
  BACKGROUND
  CAV continues to limit the long-term survival of heart transplant recipients. Coronary angiography has a Class I recommendation for CAV surveillance and annual or biannual surveillance angiography is performed routinely in most centers.
  
  
  METHODS
  All transplant recipients referred for surveillance angiography at a single UK center over a 2-year period were prospectively screened for study eligibility. Patients prospectively underwent coronary angiography followed by coronary intravascular ultrasound, fractional flow reserve, and index of microcirculatory resistance. Within 1 month, patients underwent multiparametric CMR, including assessment of regional and global ventricular function, absolute myocardial blood flow quantification, and myocardial tissue characterization. In addition, 10 healthy volunteers underwent CMR.
  
  
  RESULTS
  Forty-eight patients were recruited, median 7.1 years (interquartile range: 4.6 to 10.3 years) since transplantation. The CMR myocardial perfusion reserve was the only independent predictor of both epicardial (β = -0.57, p < 0.001) and microvascular disease (β = -0.60, p < 0.001) on stepwise multivariable regression. The CMR myocardial perfusion reserve significantly outperformed angiography for detecting moderate CAV (area under the curve, 0.89 [95% confidence interval (CI): 0.79 to 1.00] vs. 0.59 [95% CI: 0.42 to 0.77], p = 0.01) and severe CAV (area under the curve, 0.88 [95% CI: 0.78 to 0.98] vs. 0.67 [95% CI: 0.52 to 0.82], p = 0.05).
  
  
  CONCLUSIONS
  CAV, including epicardial and microvascular components, can be detected more accurately using noninvasive CMR-based absolute myocardial blood flow assessment than with invasive coronary angiography, the current clinical surveillance technique.
authors.affiliation: North West Heart Centre and Transplant Centre, University Hospital of South Manchester, Wythenshawe Hospital, Manchester, United Kingdom; Centre for Imaging Sciences and Biomedical Imaging Institute, University of Manchester, Manchester, United Kingdom; Institute of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom. Electronic address: chrismiller@doctors.org.uk.
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Miller
authors.affiliation: North West Heart Centre and Transplant Centre, University Hospital of South Manchester, Wythenshawe Hospital, Manchester, United Kingdom; Institute of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom.
authors.forename: Jaydeep
authors.initials: J
authors.lastname: Sarma
authors.affiliation: Centre for Imaging Sciences and Biomedical Imaging Institute, University of Manchester, Manchester, United Kingdom.
authors.forename: Josephine H
authors.initials: JH
authors.lastname: Naish
authors.affiliation: North West Heart Centre and Transplant Centre, University Hospital of South Manchester, Wythenshawe Hospital, Manchester, United Kingdom; Institute of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom.
authors.forename: Nizar
authors.initials: N
authors.lastname: Yonan
authors.affiliation: North West Heart Centre and Transplant Centre, University Hospital of South Manchester, Wythenshawe Hospital, Manchester, United Kingdom; Institute of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom.
authors.forename: Simon G
authors.initials: SG
authors.lastname: Williams
authors.affiliation: North West Heart Centre and Transplant Centre, University Hospital of South Manchester, Wythenshawe Hospital, Manchester, United Kingdom; Institute of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Shaw
authors.affiliation: Alliance Medical Cardiac MRI Unit, Wythenshawe Hospital, Manchester, United Kingdom.
authors.forename: David
authors.initials: D
authors.lastname: Clark
authors.affiliation: North West Heart Centre and Transplant Centre, University Hospital of South Manchester, Wythenshawe Hospital, Manchester, United Kingdom.
authors.forename: Keith
authors.initials: K
authors.lastname: Pearce
authors.affiliation: North West Heart Centre and Transplant Centre, University Hospital of South Manchester, Wythenshawe Hospital, Manchester, United Kingdom.
authors.forename: Martin
authors.initials: M
authors.lastname: Stout
authors.affiliation: North West Heart Centre and Transplant Centre, University Hospital of South Manchester, Wythenshawe Hospital, Manchester, United Kingdom; Centre for Imaging Sciences and Biomedical Imaging Institute, University of Manchester, Manchester, United Kingdom.
authors.forename: Rahul
authors.initials: R
authors.lastname: Potluri
authors.affiliation: North West Heart Centre and Transplant Centre, University Hospital of South Manchester, Wythenshawe Hospital, Manchester, United Kingdom.
authors.forename: Alex
authors.initials: A
authors.lastname: Borg
authors.affiliation: Christie Medical Physics and Engineering, Christie Hospital, Manchester, United Kingdom.
authors.forename: Glyn
authors.initials: G
authors.lastname: Coutts
authors.affiliation: North West Heart Centre and Transplant Centre, University Hospital of South Manchester, Wythenshawe Hospital, Manchester, United Kingdom; Institute of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom.
authors.forename: Saqib
authors.initials: S
authors.lastname: Chowdhary
authors.affiliation: NIHR Leicester Cardiovascular Biomedical Research Unit and Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom.
authors.forename: Gerry P
authors.initials: GP
authors.lastname: McCann
authors.affiliation: Centre for Imaging Sciences and Biomedical Imaging Institute, University of Manchester, Manchester, United Kingdom.
authors.forename: Geoffrey J M
authors.initials: GJ
authors.lastname: Parker
authors.affiliation: North West Heart Centre and Transplant Centre, University Hospital of South Manchester, Wythenshawe Hospital, Manchester, United Kingdom; Institute of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom.
authors.forename: Simon G
authors.initials: SG
authors.lastname: Ray
authors.affiliation: North West Heart Centre and Transplant Centre, University Hospital of South Manchester, Wythenshawe Hospital, Manchester, United Kingdom; Institute of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom.
authors.forename: Matthias
authors.initials: M
authors.lastname: Schmitt
mesh_terms: D000328:Adult; D000368:Aged; D064591:Allografts / Q000473:pathology* / Q000502:physiology; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000473:pathology; D003326:Coronary Circulation / Q000502:physiology*; D005260:Female; D016027:Heart Transplantation / Q000009:adverse effects* / Q000639:trends; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
keywords: cardiac allograft vasculopathy; cardiovascular magnetic resonance; diagnosis; microvascular disease; myocardial blood flow