Late Gadolinium Enhancement in Cardiac Transplant Patients Is Associated With Adverse Ventricular Functional Parameters and Clinical Outcomes

Abstract Background Heart transplant recipients (HTRs) experience multiple cardiac complications, many of which might produce myocardial fibrosis. Cardiovascular magnetic resonance imaging (CMR) can image myocardial fibrosis using late gadolinium enhancement (LGE) imaging. We hypothesized that the p...

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Bibliographic Details
Published in:Canadian journal of cardiology 2013-09, Vol.29 (9), p.1076-1083
Main Authors: Butler, Craig R., MD, MSc, Kumar, Andreas, MD, MSc, Toma, Mustafa, MD, Thompson, Richard, PhD, Chow, Kelvin, PhD, Isaac, Debra, MD, Kim, Daniel, MD, Haykowsky, Mark, PhD, Friedrich, Matthias G., MD, Paterson, Ian, MD, FRCPC
Format: Article
Language:English
Subjects:
Adult
Aged
Cardiovascular
Contrast Media - adverse effects
Death
Female
Fibrosis
Follow-Up Studies
Gadolinium DTPA - adverse effects
Heart Transplantation
Hospitalization - statistics & numerical data
Humans
Image Enhancement - methods
Magnetic Resonance Imaging - methods
Male
Middle Aged
Myocardium - pathology
Postoperative Complications
Prognosis
Stroke Volume - drug effects
Ventricular Dysfunction, Left - chemically induced
Ventricular Dysfunction, Left - physiopathology
Ventricular Remodeling - drug effects
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Summary:Abstract Background Heart transplant recipients (HTRs) experience multiple cardiac complications, many of which might produce myocardial fibrosis. Cardiovascular magnetic resonance imaging (CMR) can image myocardial fibrosis using late gadolinium enhancement (LGE) imaging. We hypothesized that the presence and volume of LGE in heart transplant recipients correlates with left ventricular (LV) functional parameters and clinical outcomes. Methods Thirty-eight stable HTRs underwent a CMR study and clinical follow-up. Results In 38 stable HTRs, LGE was seen in 19 patients (50%), of which 15 (79%) had a nonischemic pattern and 4 (21%) had an ischemic pattern. LGE volume was associated with reduced LV ejection fraction (EF) ( R2  = 0.57; P  = 0.001) and increased LV end-diastolic volume ( R2  = 0.59; P  = 0.001). The presence of LGE was associated with cardiovascular death or hospitalization within the next year ( P  = 0.04), and patients who died or were hospitalized had more LGE than those that were not hospitalized (15 g vs 7 g; P  = 0.03). Conclusions LGE is common in HTR and is associated with adverse ventricular remodelling and adverse clinical outcomes. LGE might be a useful noninvasive approach to monitor graft disease in asymptomatic patients after heart transplant.
ISSN:0828-282X
1916-7075
DOI:10.1016/j.cjca.2012.10.021