Abstract
BackgroundCardiac 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.Methods10 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.ResultsCardiac 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.ConclusionA 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.
Highlights
Since the development of heart transplantation for treatment of end-stage heart failure, the early diagnosis of transplant rejection has become essential
Regular followup contributes to detection of complications like coronary allograft vasculopathy and chronic transplant rejection which can result in significant graft coronary artery disease or myocardial fibrosis with loss of contractility
Comparison of coronary angiography and multi-slice spiral computed tomography By coronary angiography and multi-slice spiral computed tomography lesions in the epimyocardial vessel segments could be correctly detected in all patients (Table 1). 2 patients showed diffuse atherosclerotic lesions and coronary artery disease was diagnosed in 2 patients (patient no. 2: stenosis of the left main stem and left anterior descending artery (Figure 1), Calcium mass 0.13 in mg calcium hydroxyapatite (CaHa); patient no. 10: stenosis of the left anterior descending artery which was treated 5 days later by percutaneous coronary intervention
Summary
Since the development of heart transplantation for treatment of end-stage heart failure, the early diagnosis of transplant rejection has become essential. Coronary allograft vasculopathy is usually clinically silent and presents a diagnostic challenge; because of continued denervation in the majority of heart transplants, any occurrence of myocardial ischemia in those grafts is asymptomatic with angina being rarely. They might manifest sequelae of coronary artery disease, including signs of congestive heart failure or loss of transplant function, or they may experience arrhythmias or sudden death. We compared multi-slice computed tomography and magnetic resonance imaging with invasive methods like coronary angiography and left endomyocardial biopsy
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