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CLINICAL STUDY: HEART TRANSPLANT

Detection and prediction of acute heart transplant rejection with the myocardial T₂ determination provided by a black-blood magnetic resonance imaging sequence

Pierre Y. Marie, MD^*, Michael Angioï, MD, Jean P. Carteaux, MD, Jean M. Escanye, PhD^*, Sophie Mattei, MD, Kiril Tzvetanov, MD, Olivier Claudon, MD, Nathalie Hassan, MD^*, Nicolas Danchin, MD, Gilles Karcher, MD^*, Alain Bertrand, MD^*, Paul M. Walker, PhD and Jean P. Villemot, MD

^* Department of Nuclear Medicine, UPRES EA 2403, CHU Nancy, France
Department of Cardiology, UPRES EA 2403, CHU Nancy, France
Department of Cardiac Surgery, UPRES EA 2403, CHU Nancy, France
Department of Nuclear Medicine, CHU Dijon, France

Manuscript received May 8, 2000; revised manuscript received September 29, 2000, accepted November 10, 2000.

Reprint requests and correspondence: Pr. Pierre-Yves Marie, Service de Médecine Nucléaire, Chu Nancy-Brabois, 54511 Vandoeuvre Cedex, France
py.marie{at}chu-nancy.fr

OBJECTIVES

This study aimed to determine whether the myocardial T₂ relaxation time, determined using a black-blood magnetic resonance imaging (MRI) sequence, could predict acute heart transplant rejection.

BACKGROUND

The use of black-blood MRI sequences allows suppression of the confusing influence of blood signal when myocardial T₂ is calculated to detect myocardial edema.

METHODS

A total of 123 investigations, including cardiac MRI and myocardial biopsy, were performed 8 ± 11 months after heart transplantation. Myocardial T₂ was determined using an original inversion-recovery/spin-echo sequence.

RESULTS

A higher than normal T₂ (56 ms) allowed an accurate detection of the moderate acute rejections evidenced at baseline biopsy (International Society for Heart and Lung Transplantation grade 2): sensitivity, 89% and specificity, 70% (p < 0.0001). T₂ was increased in grade 2 (n = 11) compared with grade 0 (n = 49, p < 0.05), grade 1A (n = 34, p < 0.05) and grade 1B (n = 21, p < 0.05); T₂ was further increased in grade 3 (n = 8) compared with grade 2 (p < 0.05). In addition, in patients without rejection equal to or greater than grade 2 at baseline, a T₂ higher than normal (56 ms) was correlated with the subsequent occurrence of equal or greater than grade 2 rejection within the next three months: sensitivity 63% (12/19) and specificity 78% (64/82) (p = 0.001).

CONCLUSIONS

Myocardial T₂, determined using a black-blood MRI sequence, is sufficiently sensitive to identify most of the moderate acute rejections documented with biopsy at the same time, but is also a predictor of the subsequent occurrence of such biopsy-defined rejections.

Abbreviations and Acronyms   IVRT = isovolumetric relaxation time   LV = left ventricle   MRI = magnetic resonance imaging   PHT = pressure half-time   SD = standard deviation   T2 = [H+] transversal relaxation time

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