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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

View larger version (73K): [in a new window]   Figure 1 Perfusion analysis. (a) Four (of 50) images per slice showing the first pass of the contrast through the heart (picture 1 = baseline image; picture 2 = contrast in the right ventricle; picture 3 = contrast in the left ventricle; picture 4 = contrast in the myocardium). (b) Manual endomyocardial and epimyocardial contour delineation, an automated algorithm matches the contours to the remaining images of the slice. (c) Signal intensity (SI) curves of the contrast media through the left ventricle (LVin), the endomyocardium (endo) and epimyocardium (epi). Model-constrained deconvolution was used to calculate the maximum amplitude of the impulse response function from the SI curves (12).

View larger version (12K): [in a new window]   Figure 2 Myocardial perfusion reserve in volunteers group A, B, and C of the transplant recipients. *p < 0.0001 versus volunteers; p < 0.0001 versus volunteers and A; p < 0.01 versus B; p < 0.03 between A and B.

View larger version (11K): [in a new window]   Figure 3 Endomyocardial/epimyocardial perfusion ratio in volunteers group A, B, and C of the transplant recipients. *p < 0.0001 versus volunteers and A; p < 0.04 versus B.

View larger version (14K): [in a new window]   Figure 4 Linear correlation of (A) coronary flow reserve (CFR) and myocardial perfusion reserve (MPR) and (B) endomyocardial/epimyocardial perfusion ratios (Endo/Epi ratios) and CFR in transplant patients. Values in the right lower quadrant represent false positive for transplant arteriopathy (Tx-CHD) as determined by the MPR (A) or Endo/Epi ratios (B); values in the left upper quadrant represents false-negative for Tx-CHD as determined by the MPR (A) or Endo/Epi ratio (B). Cutoff values (dotted lines) for MPR (A) and Endo/Epi (B) ratios as determined by receiver operating characteristic analysis (see text for details). Circles = group A; squares = group B; triangles = group C of the transplant patients.