title: Diagnostic performance of late gadolinium enhancement in the assessment of acute cellular rejection after heart transplantation.
abstract: OBJECTIVE
  Allograft rejection is still an important cause of morbidity and mortality after heart transplantation (HTx). Many techniques in cardiac magnetic resonance imaging (CMR) were investigated to diagnose acute cellular rejection (ACR). However, there is not enough information about late gadolinium enhancement (LGE) in the myocardium and ACR.
  
  
  METHODS
  We prospectively analyzed our consecutive 41 heart transplant recipients who were admitted for routine endomyocardial biopsies. CMR was performed maximum 6 h before the scheduled endomyocardial biopsy. Correlation between LGE in the myocardium and ACR was investigated.
  
  
  RESULTS
  Twenty-seven patients showed no rejection, and nine of them had LGE in the myocardium. Fourteen patients had LGE in the left ventricle (LV), and two patients had LGE also in the right ventricle (RV). There was no correlation between LGE and ACR (p=0.879). There was no difference in the left ventricular ejection fraction (LVEF), right ventricular fractional area change (RVFAC), and cardiac ischemic time between the groups (p=0.825, p=0.370, and p=0.419, respectively). LGE in the myocardium could be due to previous rejection episodes; therefore, all patients were retrospectively searched for previous rejection grades and number of episodes. Thirty-eight of the 41 patients had a history of one ACR episode, but none of them had a statistically significant correlation with LGE (for grade 1R, p=0.964 and grade 3R, p=1) There was also no correlation between number of rejection episodes history and LGE.
  
  
  CONCLUSIONS
  LGE is not suitable to detect ACR in heart transplant patients. LGE and the history of ACR have no correlation.
authors.affiliation: Department of Cardiology, Faculty of Medicine, Ege University; İzmir-Turkey. drevrimsimsek@gmail.com.
authors.forename: Evrim
authors.initials: E
authors.lastname: Şimşek
authors.forename: Sanem
authors.initials: S
authors.lastname: Nalbantgil
authors.forename: Naim
authors.initials: N
authors.lastname: Ceylan
authors.forename: Mehdi
authors.initials: M
authors.lastname: Zoghi
authors.forename: Hatice Soner
authors.initials: HS
authors.lastname: Kemal
authors.forename: Çağatay
authors.initials: Ç
authors.lastname: Engin
authors.forename: Tahir
authors.initials: T
authors.lastname: Yağdı
authors.forename: Mustafa
authors.initials: M
authors.lastname: Özbaran
mesh_terms: D000328:Adult; D003287:Contrast Media / Q000008:administration & dosage*; D005260:Female; D019786:Gadolinium DTPA / Q000008:administration & dosage*; D006084:Graft Rejection / Q000000981:diagnostic imaging*; D016027:Heart Transplantation; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D011237:Predictive Value of Tests; D011446:Prospective Studies
chemical_list: D003287:Contrast Media; D019786:Gadolinium DTPA