Top

Published in:

Open Access 01-12-2009 | Research article

The challenge to detect heart transplant rejection and transplant vasculopathy non-invasively - a pilot study

Authors: Engin Usta, Christof Burgstahler, Hermann Aebert, Stephen Schroeder, Uwe Helber, Andreas F Kopp, Gerhard Ziemer

Published in: Journal of Cardiothoracic Surgery | Issue 1/2009

Abstract

Background

Cardiac allograft rejection and vasculopathy are the main factors limiting long-term survival after heart transplantation.

In this pilot study we investigated whether non-invasive methods are beneficial to detect cardiac allograft rejection (Grade 0-3 R) and cardiac allograft vasculopathy. Thus we compared multi-slice computed tomography and magnetic resonance imaging with invasive methods like coronary angiography and left endomyocardial biopsy.

Methods

10 asymptomatic long-term survivors after heart transplantation (8 male, 2 female, mean age 52.1 ± 12 years, 73 ± 11 months after transplantation) were included. In a blinded fashion, coronary angiography and multi-slice computed tomography and ventricular endomyocardial biopsy and magnetic resonance imaging were compared against each other.

Results

Cardiac allograft vasculopathy and atherosclerosis were correctly detected by multi-slice computed tomography and coronary angiography with positive correlation (r = 1). Late contrast enchancement found by magnetic resonance imaging correlated positively (r = 0.92, r² = 0.85, p < 0.05) with the histological diagnosis of transplant rejection revealed by myocardial biopsy. None of the examined endomyocardial specimen revealed cardiac allograft rejection greater than Grade 1 R.

Conclusion

A combined non-invasive approach using multi-slice computed tomography and magnetic resonance imaging may help to assess cardiac allograft vasculopathy and cardiac allograft rejection after heart transplantation before applying more invasive methods.

Available only for authorised users

Komatsu S, Hirayama A, Omori Y, Ueda Y, Mizote I, Fujisawa Y, Kiyomoto M, Higashide T, Kodama K: Detection of Coronary Plaque by Computed Tomography With a Novel Plaque Analysis System, 'Plaque Map', and Comparison With Intravascular Ultrasound and Angioscopy. Circ J. 2005, 69 (1): 72-7. 10.1253/circj.69.72.CrossRefPubMed

Baraldi-Junkins C, Levin HR, Kasper EK, Rayburn BK, Herskowitz A, Baughman KL: Complications of Endomyocardial Biopsy in Heart Transplant Patients. J Heart Lung Transplant. 1993, 12 (1 Pt 1): 63-7.PubMed

Shan K, Constantine G, Sivananthan M, Flamm SD: Role of Cardiac Magnetic Resonance Imaging in the Assessment of Myocardial Viability. Circulation. 2004, 109 (11): 1328-34. 10.1161/01.CIR.0000120294.67948.E3.CrossRefPubMed

Goetze S, Sigurdsson G, Greenberg NL, Yamani H, Garcia MJ: Images in Cardiovascular Medicine. Transplant Vasculopathy: Evaluation With Multi-Detector Computed Tomography. Circulation. 2004, 110 (9): e80-e81. 10.1161/01.CIR.0000140671.80741.E1.CrossRefPubMed

Stewart S, Winters GL, Fishbein MC, Tazelaar HD, Kobashigawa J, Abrams J, Andersen CB, Angelini A, Berry GJ, Burke MM, Demetris AJ, Hammond E, Itescu S, Marboe CC, McManus B, Reed EF, Reinsmoen NL, Rodriguez ER, Rose AG, Rose M, Suciu-Focia N, Zeevi A, Billingham ME: Revision of the Working Formulation for the Standardization of Nomenclature in the Diagnosis of Heart Rejection. J Heart Lung Transplant. 1990, 24 (11): 1710-20. 10.1016/j.healun.2005.03.019.CrossRef

Johansson L, Johnsson C, Penno E, Bjornerud A, Ahlstrom H: Acute Cardiac Transplant Rejection: Detection and Grading With MR Imaging With a Blood Pool Contrast Agent-Experimental Study in the Rat. Radiology. 2002, 225 (1): 97-103. 10.1148/radiol.2251010698.CrossRefPubMed

Kim RJ, Chen EL, Lima JA, Judd RM: Myocardial Gd-DTPA Kinetics Determine MRI Contrast Enhancement and Reflect the Extent and Severity of Myocardial Injury After Acute Reperfused Infarction. Circulation. 1996, 94 (12): 12-3318.CrossRef

Hoffmann U, Brady TJ, Muller J: Cardiology Patient Page. Use of New Imaging Techniques to Screen for Coronary Artery Disease. Circulation. 2003, 108 (8): e50-e53. 10.1161/01.CIR.0000085363.88377.F2.CrossRefPubMed

10.

Schoepf UJ, Becker CR, Ohnesorge BM, Yucel EK: CT of Coronary Artery Disease. Radiology. 2004, 232 (1): 18-37. 10.1148/radiol.2321030636.CrossRefPubMed

11.

Romeo G, Houyel L, Angel CY, Brenot P, Riou JY, Paul JF: Coronary Stenosis Detection by 16-Slice Computed Tomography in Heart Transplant Patients: Comparison With Conventional Angiography and Impact on Clinical Management. J Am Coll Cardiol. 2005, 45 (11): 1826-31. 10.1016/j.jacc.2005.02.069.CrossRefPubMed

12.

Billingham ME: Cardiac Transplant Atherosclerosis. Transplant Proc. 1987, 19 (4 Suppl 5): 19-25.PubMed

13.

Aranda JM, Hill J: Cardiac Transplant Vasculopathy. Chest. 2000, 118 (6): 1792-800. 10.1378/chest.118.6.1792.CrossRefPubMed

14.

Salomon RN, Hughes CC, Schoen FJ, Payne DD, Pober JS, Libby P: Human Coronary Transplantation-Associated Arteriosclerosis. Evidence for a Chronic Immune Reaction to Activated Graft Endothelial Cells. Am J Pathol. 1991, 138 (4): 791-8.PubMedPubMedCentral

15.

Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte M, Detrano R: Quantification of Coronary Artery Calcium Using Ultrafast Computed Tomography. J Am Coll Cardiol. 1990, 15 (4): 827-32.CrossRefPubMed

16.

Wang S, Detrano RC, Secci A, Tang W, Doherty TM, Puentes G, Wong N, Brundage BH: Detection of Coronary Calcification With Electron-Beam Computed Tomography: Evaluation of Interexamination Reproducibility and Comparison of Three Image-Acquisition Protocols. Am Heart J. 1996, 132 (3): 550-8. 10.1016/S0002-8703(96)90237-9.CrossRefPubMed

17.

Knollmann FD, Bocksch W, Spiegelsberger S, Hetzer R, Felix R, Hummel M: Electron-Beam Computed Tomography in the Assessment of Coronary Artery Disease After Heart Transplantation. Circulation. 2000, 101 (17): 2078-82.CrossRefPubMed

18.

Shemesh J, Tenenbaum A, Stroh CI, Apter S, Har-Zahav Y, Fisman EZ, Itzchak Y, Motro M: Double-Helical CT As a New Tool for Tracking of Allograft Atherosclerosis in Heart Transplant Recipients. Invest Radiol. 1999, 34 (7): 485-8. 10.1097/00004424-199907000-00007.CrossRefPubMed

19.

Hong C, Bae KT, Pilgram TK, Suh J, Bradley D: Coronary Artery Calcium Measurement With Multi-Detector Row CT: in Vitro Assessment of Effect of Radiation Dose. Radiology. 2002, 225 (3): 901-6. 10.1148/radiol.2253011871.CrossRefPubMed

20.

Costanzo MR, Naftel DC, Pritzker MR, Heilman JK, Boehmer JP, Brozena SC, Dec GW, Ventura HO, Kirklin JK, Bourge RC, Miller LW: Heart Transplant Coronary Artery Disease Detected by Coronary Angiography: a Multiinstitutional Study of Preoperative Donor and Recipient Risk Factors. Cardiac Transplant Research Database. J Heart Lung Transplant. 1998, 17 (8): 744-53.PubMed

21.

Hosenpud JD, Shipley GD, Wagner CR: Cardiac Allograft Vasculopathy: Current Concepts, Recent Developments, and Future Directions. J Heart Lung Transplant. 1992, 11 (1 Pt 1): 9-23.PubMed

22.

Wagner A, Mahrholdt H, Sechtem U, Kim RJ, Judd RM: MR Imaging of Myocardial Perfusion and Viability. Magn Reson Imaging Clin N Am. 2003, 11 (1): 49-66. 10.1016/S1064-9689(02)00048-X.CrossRefPubMed

23.

Mahrholdt H, Wagner A, Judd RM, Sechtem U: Assessment of Myocardial Viability by Cardiovascular Magnetic Resonance Imaging. Eur Heart J. 2002, 23 (8): 602-19. 10.1053/euhj.2001.3038.CrossRefPubMed

24.

Choudhury L, Mahrholdt H, Wagner A, Choi KM, Elliott MD, Klocke FJ, Bonow RO, Judd RM, Kim RJ: Myocardial Scarring in Asymptomatic or Mildly Symptomatic Patients With Hypertrophic Cardiomyopathy. J Am Coll Cardiol. 2002, 40 (12): 2156-64. 10.1016/S0735-1097(02)02602-5.CrossRefPubMed

25.

Weinsaft JW, Klem I, Judd RM: MRI for the Assessment of Myocardial Viability. Magn Reson Imaging Clin N Am. 2007, 15 (4): 505-vi. 10.1016/j.mric.2007.08.007.CrossRefPubMed

26.

Schuetz A, Kemkes BM, Breuer M, Brandl U, Engelhardt M, Kugler C, Manz C, Hatz R, Gokel JM, Hammer C: Kinetics and Dynamics of Acute Rejection After Heterotopic Heart Transplantation. J Heart Lung Transplant. 1992, 11 (2 Pt 1): 289-99.PubMed

27.

Steen H, Merten C, Refle S, Klingenberg R, Dengler T, Giannitsis E, Katus HA: Prevalence of Different Gadolinium Enhancement Patterns in Patients After Heart Transplantation. J Am Coll Cardiol. 2008, 52 (14): 1160-7. 10.1016/j.jacc.2008.05.059.CrossRefPubMed

Title: The challenge to detect heart transplant rejection and transplant vasculopathy non-invasively - a pilot study
Authors: Engin Usta
Christof Burgstahler
Hermann Aebert
Stephen Schroeder
Uwe Helber
Andreas F Kopp
Gerhard Ziemer
Publication date: 01-12-2009
Publisher: BioMed Central
Published in: Journal of Cardiothoracic Surgery / Issue 1/2009
Electronic ISSN: 1749-8090
DOI: https://doi.org/10.1186/1749-8090-4-43

Keynote webinar | Spotlight on medication adherence

Springer Medicine

The challenge to detect heart transplant rejection and transplant vasculopathy non-invasively - a pilot study

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2009

Surgically cured hypoglycemia secondary to pleural solitary fibrous tumour: case report and update review on the Doege-Potter syndrome

Left ventricular diastolic dysfunction of the cardiac surgery patient; a point of view for the cardiac surgeon and cardio-anesthesiologist

An occasional diagnosis of myasthenia gravis - a focus on thymus during cardiac surgery: a case report

Current role of surgery in small cell lung carcinoma

Papillary fibroelastoma of the left atrial wall: a case report

Surgery of secondary mitral insufficiency in patients with impaired left ventricular function