Correlation of cardiovascular magnetic resonance imaging findings and endomyocardial biopsy results in patients undergoing screening for heart transplant rejection

Craig R Butler; AnaMaria Savu; Jeffrey A Bakal; Mustafa Toma; Richard Thompson; Kelvin Chow; Harris Wang; Daniel H Kim; Michael Mengel; Mark Haykowsky; Glen J Pearson; Padma Kaul; Ian Paterson

doi:10.1016/j.healun.2014.12.020

Correlation of cardiovascular magnetic resonance imaging findings and endomyocardial biopsy results in patients undergoing screening for heart transplant rejection

J Heart Lung Transplant. 2015 May;34(5):643-50. doi: 10.1016/j.healun.2014.12.020. Epub 2015 Jan 8.

Authors

Affiliations

¹ Division of Cardiology, Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada.
² Patient Health Outcomes Research and Clinical Efficacy Unit.
³ Department of Biomedical Engineering.
⁴ Department of Laboratory Medicine and Pathology.
⁵ Department of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada.
⁶ Division of Cardiology, Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada. Electronic address: ip3@ualberta.ca.

PMID: 25934478
DOI: 10.1016/j.healun.2014.12.020

Abstract

Background: Endomyocardial biopsy (EMB) is the current gold standard to screen for heart transplant rejection but has important risks and limitations. Cardiovascular magnetic resonance imaging (CMRI) is increasingly used to characterize cardiac function and myocardial tissue. We evaluated the diagnostic accuracy of CMRI compared with EMB and clinically diagnosed heart transplant rejection.

Methods: Comprehensive CMRI scans were performed on adult heart transplant recipients within 24 hours of EMB (routine or clinically indicated), before initiation of any anti-rejection therapy, and blinded to EMB results. Multivariable analysis was used to create CMRI diagnostic criteria for comparison with a positive EMB (Grade ≥ 2R or antibody-mediated rejection) and clinical rejection (change in medical therapy to treat rejection).

Results: Sixty participants (75% male; mean age, 51 ± 14 years) were recruited, providing 73 comparisons between CMRI and EMB for the diagnosis of rejection. Multivariable logistic regression identified myocardial edema (T2 relaxation time) and right ventricular end-diastolic volume index as independent predictors of a positive EMB. Combining threshold right ventricular end-diastolic volume index and edema values predicted a positive EMB with very good accuracy: sensitivity, 93%; specificity, 78%; positive predictive value, 52%; and negative predictive valve, 98%. CMRI was more sensitive than EMB at predicting clinical rejection (sensitivity of 67% vs 58%).

Conclusions: CMRI has high sensitivity and high negative predictive value in predicting biopsy-positive heart transplant rejection and may be useful as a screening test before routine EMB. CMRI also has better sensitivity for clinically diagnosed heart transplant rejection and could be helpful in cases of negative rejection on the biopsy specimen.

Keywords: acute transplant rejection; cardiovascular MRI; heart transplantation.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Alberta / epidemiology
Biopsy*
Cardiac Catheterization
Diagnosis, Differential
Female
Follow-Up Studies
Graft Rejection / epidemiology
Graft Rejection / pathology*
Heart Transplantation*
Humans
Incidence
Magnetic Resonance Imaging, Cine / methods*
Male
Middle Aged
Myocardium / pathology*
Reproducibility of Results
Retrospective Studies