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CLINICAL RESEARCH: HEART FAILURE/CARDIAC TRANSPLANTATION

Reduced myocardial perfusion reserve and transmural perfusiongradient in heart transplant arteriopathyassessed by magnetic resonance imaging

Olaf M. Muehling, MD^*,*, Norbert M. Wilke, MD, Prasad Panse, MD, Michael Jerosch-Herold, PhD^*, Betsy V. Wilson, RN, Robert F. Wilson, MD, FACC and Leslie W. Miller, MD, FACC

^* Section of Cardiovascular MRI of the Department of Diagnostic Radiology, University of Minnesota Medical School Minneapolis, Minneapolis, Minnesota, USA
Cardiovascular Division of the Department of Medicine, University of Minnesota Medical School Minneapolis, Minneapolis, Minnesota, USA
Department of Radiology, University of Florida, Jacksonville, Florida, USA

Manuscript received March 7, 2003; revised manuscript received May 22, 2003, accepted May 30, 2003.

^* Reprint requests and correspondence: Dr. Olaf Muehling, I. Medical Hospital, Grosshadern Campus, University of Munich, Marchioninistr. 15, 81377 Munich, Germany.
omuehlin{at}helios.med.uni-muenchen.de

OBJECTIVES: The goal of this study was to detect transplant arteriopathy (Tx-CHD) by a reduced myocardial perfusion reserve (MPR) and resting endomyocardial/epimyocardial perfusion ratio (Endo/Epi ratio).

BACKGROUND: Transplant arteriopathy often lacks clinical symptoms and is the reason for frequent surveillance angiography in heart transplant (Tx) recipients. Magnetic resonance perfusion imaging (MRPI) allows noninvasive assessment of transmural and selective endomyocardial and epimyocardial perfusion.

METHODS: Fifteen healthy volunteers (controls) and three groups (A, B, C) of Tx recipients were included. In controls and patients, MPR (hyperemic/resting perfusion) and Endo/Epi ratio were determined with MRPI after injection of gadolinium-diethylenetriamine pentaacetic acid at rest and during hyperemia (intravenous adenosine). Group A (n = 10) had no left ventricular (LV) hypertrophy and/or prior rejection, while patients in group B (n = 10) had at least one of these characteristics. Patients in group A and B had a normal coronary angiogram and a coronary flow reserve (CFR) of 2.5 (CFR = hyperemic/resting blood flow). Group C (n = 7) had Tx-CHD diagnosed by angiography and a reduced CFR (<2.5).

RESULTS: In group C, MPR (1.7 ± 0.5) and Endo/Epi ratio (1.1 ± 0.2) were significantly reduced compared with controls (4.2 ± 0.7 and 1.6 ± 0.3; both p < 0.0001), group A (3.6 ± 0.7 and 1.6 ± 0.2; both p < 0.0001) and B (2.7 ± 0.9, p < 0.01 and 1.4 ± 0.1, p < 0.04). Transplant arteriopathy can be excluded by an MPR of >2.3 with sensitivity and specificity of 100% and 85%. If LV hypertrophy and prior rejection are excluded, Tx-CHD can be excluded by an Endo/Epi ratio of >1.3 with 100% and 80%.

CONCLUSIONS: Magnetic resonance perfusion imaging detects Tx-CHD by a decreased MPR. After exclusion of LV hypertrophy and prior rejection, resting Endo/Epi ratio alone might be sufficient to indicate Tx-CHD.

Abbreviations and Acronyms   AUC   area under the curve   CFR   coronary flow reserve (invasive)   CI   confidence interval   Endo/Epi ratio   resting endomyocardial/epimyocardial perfusion ratio   ICUS   intracoronary ultrasound   LV   left ventricle/ventricular   MPR   myocardial perfusion reserve (noninvasive)   MRPI   magnetic resonance perfusion imaging   RPP   rate-pressure product   SI   signal intensity   Tx   transplant   Tx-CHD   transplant arteriopathy

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