title: Late gadolinium enhancement assessed by cardiac magnetic resonance imaging in heart transplant recipients with different stages of cardiac allograft vasculopathy.
abstract: OBJECTIVE
  Cardiac allograft vasculopathy (CAV), which limits long-term survival after heart transplantation (HTX), is usually evaluated by coronary angiography (CA). Late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) is a non-invasive technique that can detect CAV-related myocardial infarctions. We aimed to investigate the presence of LGE infarct-typical patterns in a large sample of HTX recipients and to correlate these findings with the severity of CAV assessed by CA.
  
  
  RESULTS
  LGE-CMR was performed in 132 HTX patients on a 1.5-T MRI scanner (Philips, Best, the Netherlands). Infarct-typical LGE areas were identified as bright lesions with subendocardial involvement. Infarct-atypical LGE was classified as follows: (i) right ventricle (RV) insertion, (ii) intramural, (iii) epicardial, and (iv) diffuse. CA was performed for the assessment of CAV (CAV0 = no lesion, CAV1 = mild lesions, CAV2 = moderate lesions, CAV3 = severe lesions, or mild/moderate lesions with allograft dysfunction). Infarct-typical LGE patterns were detected in 29 (22%) patients distributed in all groups and they were already present in nearly every fifth CAV0 patient, increasing significantly among CAV groups (CAV0 = 19%, CAV1 = 10%, CAV2 = 36%, and CAV3 = 71%; P < 0.01).
  
  
  CONCLUSIONS
  LGE-CMR was useful to identify myocardial scar possibly related to early CAV in a significant proportion of HTX recipients, otherwise classified as low-risk patients based on CA. Therefore, LGE-CMR could be helpful to intensify CAV monitoring, medical therapy, and clinical risk stratification.
authors.affiliation: Department of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg 69120, Germany School of Medicine of Ribeirao Preto, University of Sao Paulo, Sao Paulo, Brazil.
authors.forename: Maria Fernanda
authors.initials: MF
authors.lastname: Braggion-Santos
authors.affiliation: Department of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg 69120, Germany.
authors.forename: Dirk
authors.initials: D
authors.lastname: Lossnitzer
authors.affiliation: Department of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg 69120, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Buss
authors.affiliation: Institut für Diagnostische und Interventionelle Radiologie/Neuroradiologie, DIAKO Flensburg, Flensburg, Germany.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Lehrke
authors.affiliation: Department of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg 69120, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Doesch
authors.affiliation: Department of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg 69120, Germany.
authors.forename: Evangelos
authors.initials: E
authors.lastname: Giannitsis
authors.affiliation: Department of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg 69120, Germany.
authors.forename: Grigorios
authors.initials: G
authors.lastname: Korosoglou
authors.affiliation: Department of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg 69120, Germany.
authors.forename: Hugo A
authors.initials: HA
authors.lastname: Katus
authors.affiliation: Department of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg 69120, Germany henning.steen@gmx.de.
authors.forename: Henning
authors.initials: H
authors.lastname: Steen
mesh_terms: D055424:Cardiac-Gated Imaging Techniques; D003287:Contrast Media; D017023:Coronary Angiography; D005260:Female; D019786:Gadolinium DTPA; D016027:Heart Transplantation; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis*
chemical_list: D003287:Contrast Media; D019786:Gadolinium DTPA
keywords: Cardiac allograft vasculopathy; Cardiac magnetic resonance; Heart transplantation; Late gadolinium enhancement