Prognostic impact of late gadolinium enhancement in the risk stratification of heart transplant patients.
OBJECTIVE
The aim of the present study was to assess the association of the presence and amount of late gadolinium enhancement (LGE) at cardiac magnetic resonance (CMR) with cardiovascular adverse events in patients with orthotopic heart transplantation (HTx).


RESULTS
We enrolled 48 patients (mean age, 54.7 ± 14.6 years; 37 men) at various stages after HTx. All patients underwent standard CMR at 1.5 T, to characterize both cardiac anatomy and LGE. Late gadolinium enhancement was detected in 26 patients (54%). All-cause and cardiovascular mortalities, and a composite of major adverse cardiovascular events (MACE) recurrence were evaluated during the follow-up period for a median of 5.16 years. Ten patients (21%) died and 26 (54%) were readmitted because of MACE. Multivariate Cox analysis identified as independent predictors of MACE a diagnosis of cardiac allograft vasculopathy (CAV) (HR 3.63; 1.5-8.7 95% CI; P = 0.0039), left ventricular end systolic volume index (HR 1.04; 95% CI 1.01-1.079; P = 0.008), LGE mass (HR 1.04; 1.01-1.06 95% CI; P = 0.0007), LGE % of left ventricular mass (HR 1.083; 1.03-1.13 95% CI; P = 0.0002). Independent predictors of all-cause death were CAV (HR 6.33; 95% CI 1.33-30.03; P = 0.0201), LGE mass (HR 1.04; 1.01-1.07 95% CI; P = 0.005), LGE % of left ventricular mass (HR 1.075; 1.02-1.13 95% CI; P = 0.007). Patients with CAV had a risk of MACE by 5 years of 67% (95% CI 0.309-0.851%); the addition of 7.9 LGE % to the risk model increased the predicted risk to 88% (95% CI 0.572-0.967%).


CONCLUSIONS
The current study demonstrated that the presence of CAV and the total amount of LGE have a significant independent association with MACE and mortality in HTx patients.
CMR Unit, Department of Cardiology and Cardiovascular Surgery, Niguarda Ca' Granda Hospital, Milan, Italy.
Patrizia
P
Pedrotti
CMR Unit, Department of Cardiology and Cardiovascular Surgery, Niguarda Ca' Granda Hospital, Milan, Italy.|Heart Transplant Unit, Cardiology 2 Cardiovascular Department, Niguarda Ca' Granda Hospital, Milan, Italy.
Claudia
C
Vittori
Health Science Department, Bicocca University, Milan, Italy.
Rita
R
Facchetti
Cardiology 3, Cardiovascular Department, Niguarda Ca' Granda Hospital, Milan, Italy.
Stefano
S
Pedretti
CMR Unit, Department of Cardiology and Cardiovascular Surgery, Niguarda Ca' Granda Hospital, Milan, Italy.
Santo
S
Dellegrottaglie
CMR Unit, Department of Cardiology and Cardiovascular Surgery, Niguarda Ca' Granda Hospital, Milan, Italy.
Angela
A
Milazzo
Heart Transplant Unit, Cardiology 2 Cardiovascular Department, Niguarda Ca' Granda Hospital, Milan, Italy.
Maria
M
Frigerio
Heart Transplant Unit, Cardiology 2 Cardiovascular Department, Niguarda Ca' Granda Hospital, Milan, Italy.
Manlio
M
Cipriani
Health Science Department, Bicocca University, Milan, Italy.|Cardiology 4, Cardiovascular Department, Niguarda Ca' Granda Hospital, Milan, Italy.
Cristina
C
Giannattasio
CMR Unit, Department of Cardiology and Cardiovascular Surgery, Niguarda Ca' Granda Hospital, Milan, Italy.
Alberto
A
Roghi
CNR IBFM, Segrate, Italy rimoldi.ornella@hsr.it.|Cardiac Thoracic and Vascular Department, IRCCS Ospedale San Raffaele, Milan, Italy.
Ornella
O
Rimoldi
D000328:Adult; D000704:Analysis of Variance; D002423:Cause of Death; D015331:Cohort Studies; D005260:Female; D019786:Gadolinium DTPA; D006084:Graft Rejection; D006085:Graft Survival; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000401:mortality* / Q000601:surgery*; D016027:Heart Transplantation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D053208:Kaplan-Meier Estimate; D018810:Magnetic Resonance Angiography / Q000379:methods; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011856:Radiographic Image Enhancement / Q000379:methods*; D020379:Risk Adjustment; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D013997:Time Factors
D019786:Gadolinium DTPA
cardiovascular magnetic resonance; coronary allograft vasculopathy; heart transplant; late gadolinium enhancement