Abstract
MRI can provide multiparametric assessment of the cardiac allograft that can screen for common posttransplant sequelae as well as provide important prognostic information. Heart transplant recipients require lifelong screening for acute rejection and coronary allograft vasculopathy, both of which currently employ invasive screening techniques. T2-weighted MRI imaging, in particular T2 relaxation time, is an accurate predictor of acute heart transplant rejection. The serial evaluation of T2 relaxation time in heart transplant recipients could prove a useful gatekeeper to endomyocardial biopsy when screening for rejection, but randomized control trial data is needed. MRI can also screen for coronary allograft vasculopathy at macro- and microvascular levels through the use of myocardial perfusion reserve index (MPRI). MPRI outperforms invasive coronary angiography for the detection of coronary allograft vasculopathy and is strongly predictive of cardiovascular morbidity and mortality. Late gadolinium enhancement is prevalent in the heart transplant population and is associated with adverse ventricular remodeling as well as increased morbidity and mortality. The etiology of late gadolinium enhancement in this population is unclear and warrants further investigation. MRI provides uniquely accurate quantification of right ventricular volume and function, and there is emerging evidence that right ventricle volume index may be useful in screening for acute heart transplant rejection as well as posttransplant prognosis.
Published Version
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