(360) - Cardiac MRI of Heart Transplant Recipients With Previous CMV Infection Demonstrates Ventricular Hypertrophy and Dysfunction

Abstract

Purpose: Cytomegalovirus (CMV) infection is common among heart transplant recipients and has adverse direct and indirect host effects. Little is known about the effects of CMV infection on cardiac allograft morphology or function. Cardiovascular MRI (CMR) is the gold standard for assessment of cardiac morphology and function. We hypothesized that history of CMV infection would be associated with myocardial scar, adverse ventricular remodeling, and reduced function. Methods: We retrospectively ascertained the pre-transplant recipient and donor CMV serology and post-transplant CMV infection (documented by CMV DNAemia) of heart transplant recipients who had undergone CMR as part of a separate research protocol. At our institution CMV surveillance is performed as part of a standardized post-transplant protocol and data were retrieved up to the time of their CMR scan. CMR variables of cardiac morphology and function were compared between recipients with and without previous CMV infection and across donor-recipient pre-transplant serology groups. Results: Forty six participants (mean age 51 +/15 yrs, 74% male, mean time since transplantation 3.7 +/4 years) were analyzed, of whom eighteen (39%) had > = 1 documented CMV infection. Previous CMV infection was associated with increased left ventricular (LV) mass (176 vs 143 g, p = 0.006), LV wall thickness (11 vs 9 mm, p = 0.002), LV mass to volume ratio (1.2 vs 1.0, p = 0.01), and reduced diastolic function (E/E` ratio 10 vs 7, p = 0.04). A greater number of CMV infections was associated with reduced right ventricular ejection fraction (RVEF) (r = -0.52, p = 0.03) and larger right ventricular end diastolic volume (r = 0.48, p = 0.05). Higher peak CMV DNAemia was also associated with reduced RVEF (r = -0.49, p = 0.04). There was no association between CMV infection and myocardial scarring. There were no significant differences in cardiac morphology across pre-transplant donor and recipient CMV sero-status groups. Conclusion: Heart transplant recipients with post-transplant CMV infection demonstrate morphologic and functional allograft changes on CMR. CMR may be helpful in characterizing the indirect effects of CMV infection on cardiac allografts.