Diffuse myocardial fibrosis among healthy pediatric heart transplant recipients: Correlation of histology, cardiovascular magnetic resonance, and clinical phenotype

2017 ◽  
Vol 21 (5) ◽  
pp. e12986 ◽  
Author(s):  
Brian Feingold ◽  
Cláudia M. Salgado ◽  
Miguel Reyes-Múgica ◽  
Stacey E. Drant ◽  
Susan A. Miller ◽  
...  
Author(s):  
Christopher A Miller ◽  
Jennifer H Jordan ◽  
Annalisa Angelini ◽  
W Gregory Hundley ◽  
Matthias Schmitt

Heart transplant recipients present with a unique set of anatomical and pathophysiological considerations. Cardiac allograft disease often presents non-specifically, requiring a low index for further investigation. Accurate assessment with standard imaging modalities can be difficult, and cardiovascular magnetic resonance (CMR) is increasingly requested for further clarification. The anatomy of the transplanted heart, common transplant pathologies, and the role of CMR are described.


Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Jonathan H Soslow ◽  
Justin Godown ◽  
David Bearl ◽  
Kimberly Crum ◽  
Kristen George-Durrett ◽  
...  

Introduction: Pediatric heart transplant recipients (PHTx) undergo frequent surveillance endomyocardial biopsies (EMB). Non-invasive screening for acute rejection (AR) could decrease morbidity, improve quality of life, and decrease healthcare costs. Hypothesis: We hypothesized that cardiac magnetic resonance (CMR) extracellular volume (ECV), native T1, and T2 mapping can detect AR in PHTx. Methods: PHTx (n=29) were prospectively enrolled at two sites at time of surveillance EMB or EMB for AR. AR was defined as a clinical change or positive EMB requiring intensification of immunosuppression. Subjects with cardiac allograft vasculopathy (n=3) were excluded; ECV was not measured in 2 subjects without rejection (no IV, poor breathholds). CMR without sedation included standard volumetrics, modified Look-Locker inversion recovery before and after contrast, and T2 mapping. A Wilcoxon rank sum was used to assess for a difference between groups. Results: Median age was 17 y/o (range 9-19). There were 9 subjects with and 17 subjects without AR. Base ECV, mid ECV, 4-ch ECV, and average ECV were increased in AR vs non-rejection (Table 1, Fig 1). Native T1 and T2 times were also increased in patients with AR (Table 1). A cut-off of 29% for mid ECV and 1070ms for mid native T1 identifies all patients with rejection with 6 false positive results in non-rejection (Fig 1) and could potentially decrease the need for EMB by 65%. Conclusions: ECV, native T1, and T2 mapping can non-invasively distinguish between PHTx with and without AR and have potential to decrease the required number of surveillance EMBs.


Circulation ◽  
2010 ◽  
Vol 122 (2) ◽  
pp. 138-144 ◽  
Author(s):  
Andrew S. Flett ◽  
Martin P. Hayward ◽  
Michael T. Ashworth ◽  
Michael S. Hansen ◽  
Andrew M. Taylor ◽  
...  

2016 ◽  
Vol 35 (4) ◽  
pp. S75
Author(s):  
A. Joong ◽  
M.E. Richmond ◽  
K.O. Stack ◽  
R.J. Rodriguez ◽  
J.M. McAllister ◽  
...  

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