Diagnosis and Monitoring of Acute Heart Transplant Rejection with Cardiovascular Magnetic Resonance_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

XIEFei ,  LIGang

Department of Cardiac Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin 150086, P. R. China;

Corresponding author：

LIGang, Email: gangli73@163.com

Keywords：

Magnetic resonance imaging; Heart transplantation; Rejection

DOI：

10.7507/1007-4848.20150042

Video：

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Heart transplantation is a most efficacious therapy for end-stage heart failure, but acute rejection (AR) is the biggest problem to threat longer-term survival of post-transplant patients. Currently, endomyocardial biopsy is the gold standard for the diagnosis of AR. Due to limited sample size and different tissue locations, this invasive examination may cause sampling error and significant difference between biopsy-based diagnosis and AR severity. Therefore, we need a noninvasive and repeatable method to accurately diagnose and monitor AR after heart transplantation. Cardiovascular magnetic resonance can not only observe histological changes directly from the imaging when AR occurs, but also monitor and make diagnosis of AR by evaluating T₂ relaxation time, cell labeling, cardiac functional parameters and morphological changes.

Citation： XIEFei, LIGang. Diagnosis and Monitoring of Acute Heart Transplant Rejection with Cardiovascular Magnetic Resonance. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2015, 22(2): 151-154. doi: 10.7507/1007-4848.20150042 Copy

1.	Lindenfeld J, Miller GG, Shakar SF, et al. Drug therapy in the heart transplant recipient:part II:immunosuppressive drugs. Circulation, 2004, 110(25):3858-3865.
2.	Stewart S, Winters GL, Fishbein MC, et al. Revision of the 1990 working formulation for the standardization of nomenclature in the diagnosis of heart rejection. J Heart Lung Transplant, 2005, 24(11):1710-1720.
3.	Baim DS. Endomyocardial biopsy. In:Baim DS, Grossman W, editors, eds. Grossman's Cardiac Catheterization, Angiography, and Intervention. 6th ed. Philadelphia, PA:Lippincott Williams & Wilkins, 2000. 198-205.
4.	From AM, Maleszewski JJ, Rihal CS. Current status of endomyocardial biopsy. Mayo Clin Proc, 2011, 86(11):1095-1102.
5.	Wu YL, Ye Q, Foley LM, et al. In situ labeling of immune cells with iron oxide particles:an approach to detect organ rejection by cellular MRI. Proc Natl Acad Sci USA, 2006, 103(6):1852-1857.
6.	Wu YL, Ye Q, Sato K, et al. Noninvasive evaluation of cardiac allograft rejection by cellular and functional cardiac magnetic resonance. JACC Cardiovasc Imaging, 2009, 2(6):731-741.
7.	Baraldi-Junkins C, Levin HR, Kasper EK, et al. Complications of endomyocardial biopsy in heart transplant patients. J Heart Lung Transplant, 1993, 12(1 Pt 1):63-67.
8.	Bellenger NG, Burgess MI, Ray SG, et al. Comparison of left ventricular ejection fraction and volumes in heart failure by echocardiography, radionuclide ventriculography and cardiovascular magnetic resonance; are they interchangeable? Eur Heart J, 2000, 21(16):1387-1396.
9.	Castillo E, Osman NF, Rosen BD, et al. Quantitative assessment of regional myocardial function with MR-tagging in a multi-center study:interobserver and intraobserver agreement of fast strain analysis with Harmonic Phase(HARP) MRI. J Cardiovasc Magn Reson, 2005, 7(5):783-791.
10.	Nishimura T, Sada M, Sasaki H, et al. Identification of cardiac rejection with magnetic resonance imaging in heterotopic heart transplantation model. Heart Vessels, 1987, 3(3):135-140.
11.	Taylor AJ, Vaddadi G, Pfluger H, et al. Diagnostic performance of multisequential cardiac magnetic resonance imaging in acute cardiac allograft rejection. Eur J Heart Fail, 2010, 12(1):45-51.
12.	Almenar L, Igual B, Martinez-Dolz, et al. Utility of cardiac magnetic resonance imaging for the diagnosis of heart transplant rejection. Transplant Proc, 2003, 35(5):1962-1964.
13.	Li G, Dai Gp, Xiang B, et al. Mapping myocardial viability using interleaved T1-T2 weighted imaging. Int J Cardiovasc Imaging, 2004, 20(2):135-143.
14.	Marie PY, Angioi M, Carteaux JP, et al. Detection and prediction of acute heart transplant rejection with the myocardial T2 determination provided by a black-blood magnetic resonance imaging sequence. J Am CollCardiol, 2001, 37(3):825-831.
15.	Usman AA, Taimen K, Wasielewski M, et al. Cardiac magnetic resonance T2 mapping in the monitoring and follow-up of acute cardiac transplant rejection:a pilot study. Circ Cardiovasc Imaging, 2012, 5(6):782-790.
16.	Bonnemains L, Villemin T, Escanye JM, et al. Diagnostic and prognostic value of MRI T2 quantification in heart transplant patients. Transpl Int, 2014, 27(1):69-76.
17.	Pereira NL, Zile MR, Harley RA, et al. Myocardial mechanisms causing heart failure early after cardiac transplantation. Transplant Proc, 2006, 38(9):2999-3003.
18.	Albers J, Schroeder A, de Simone R, et al. 3D evaluation of myocardial edema:experimental study on 22 pigs using magnetic resonance and tissue analysis. Thorac Cardiovasc Surg, 2001, 49(4):199-203.
19.	Liu L, Ye Q, Wu Y, et al. Tracking T-cells in vivo with a new nanosized MRI contrast agent. Nanomedicine, 2012, 8(8):1345-1354.
20.	Johansson L, Johnsson C, Penno E, et al. Acute cardiac transplant rejection:detection and grading with MR imaging with a blood pool contrast agent——experimental study in the rat. Radiology, 2002, 225(1):97-103.
21.	Wu YL, Ye Q, Eytn DF, et al. Magnetic resonance imaging investigation of macrophages in acute cardiac allograft rejection after transplantation. Circ Cardiovasc Imaging, 2013, 6(6):965-973.
22.	Kurland RJ, West J, Kelley S, et al. Magnetic resonance imaging to detect heart transplant rejection:sensitivity and specificity. Transplant Proc, 1989, 21(1 Pt 3):2537-2543.
23.	Walpoth BH, Muller MF, Celik B, et al. Assessment of cardiac rejection by MR imaging and MR-spectroscopy. Eur J Cardiothorac Surg, 1998, 14(4):426-430.
24.	Markl M, Rustogi R, Galizia M, et al. Myocardial T2-mapping and velocity mapping:changes in regional left ventricular structure and function afterheart transplantation. Magn Reson Med, 2013, 70(2):517-526.
25.	Flögel U, Su S, Kreideweiss I, et al. Noninvasive detection of graft rejection by in vivo (19)F MRI in the early stage. Am J Transplant, 2011, 11(2):235-244.
26.	Butler CR, Thompson R, Haykowsky M, et al. Cardiovascular magnetic resonance in the diagnosis of acute heart transplant rejection:a review. J Cardiovasc Magn Reson, 2009, 11:7.

1. Lindenfeld J, Miller GG, Shakar SF, et al. Drug therapy in the heart transplant recipient:part II:immunosuppressive drugs. Circulation, 2004, 110(25):3858-3865.
2. Stewart S, Winters GL, Fishbein MC, et al. Revision of the 1990 working formulation for the standardization of nomenclature in the diagnosis of heart rejection. J Heart Lung Transplant, 2005, 24(11):1710-1720.
3. Baim DS. Endomyocardial biopsy. In:Baim DS, Grossman W, editors, eds. Grossman's Cardiac Catheterization, Angiography, and Intervention. 6th ed. Philadelphia, PA:Lippincott Williams & Wilkins, 2000. 198-205.
4. From AM, Maleszewski JJ, Rihal CS. Current status of endomyocardial biopsy. Mayo Clin Proc, 2011, 86(11):1095-1102.
5. Wu YL, Ye Q, Foley LM, et al. In situ labeling of immune cells with iron oxide particles:an approach to detect organ rejection by cellular MRI. Proc Natl Acad Sci USA, 2006, 103(6):1852-1857.
6. Wu YL, Ye Q, Sato K, et al. Noninvasive evaluation of cardiac allograft rejection by cellular and functional cardiac magnetic resonance. JACC Cardiovasc Imaging, 2009, 2(6):731-741.
7. Baraldi-Junkins C, Levin HR, Kasper EK, et al. Complications of endomyocardial biopsy in heart transplant patients. J Heart Lung Transplant, 1993, 12(1 Pt 1):63-67.
8. Bellenger NG, Burgess MI, Ray SG, et al. Comparison of left ventricular ejection fraction and volumes in heart failure by echocardiography, radionuclide ventriculography and cardiovascular magnetic resonance; are they interchangeable? Eur Heart J, 2000, 21(16):1387-1396.
9. Castillo E, Osman NF, Rosen BD, et al. Quantitative assessment of regional myocardial function with MR-tagging in a multi-center study:interobserver and intraobserver agreement of fast strain analysis with Harmonic Phase(HARP) MRI. J Cardiovasc Magn Reson, 2005, 7(5):783-791.
10. Nishimura T, Sada M, Sasaki H, et al. Identification of cardiac rejection with magnetic resonance imaging in heterotopic heart transplantation model. Heart Vessels, 1987, 3(3):135-140.
11. Taylor AJ, Vaddadi G, Pfluger H, et al. Diagnostic performance of multisequential cardiac magnetic resonance imaging in acute cardiac allograft rejection. Eur J Heart Fail, 2010, 12(1):45-51.
12. Almenar L, Igual B, Martinez-Dolz, et al. Utility of cardiac magnetic resonance imaging for the diagnosis of heart transplant rejection. Transplant Proc, 2003, 35(5):1962-1964.
13. Li G, Dai Gp, Xiang B, et al. Mapping myocardial viability using interleaved T1-T2 weighted imaging. Int J Cardiovasc Imaging, 2004, 20(2):135-143.
14. Marie PY, Angioi M, Carteaux JP, et al. Detection and prediction of acute heart transplant rejection with the myocardial T2 determination provided by a black-blood magnetic resonance imaging sequence. J Am CollCardiol, 2001, 37(3):825-831.
15. Usman AA, Taimen K, Wasielewski M, et al. Cardiac magnetic resonance T2 mapping in the monitoring and follow-up of acute cardiac transplant rejection:a pilot study. Circ Cardiovasc Imaging, 2012, 5(6):782-790.
16. Bonnemains L, Villemin T, Escanye JM, et al. Diagnostic and prognostic value of MRI T2 quantification in heart transplant patients. Transpl Int, 2014, 27(1):69-76.
17. Pereira NL, Zile MR, Harley RA, et al. Myocardial mechanisms causing heart failure early after cardiac transplantation. Transplant Proc, 2006, 38(9):2999-3003.
18. Albers J, Schroeder A, de Simone R, et al. 3D evaluation of myocardial edema:experimental study on 22 pigs using magnetic resonance and tissue analysis. Thorac Cardiovasc Surg, 2001, 49(4):199-203.
19. Liu L, Ye Q, Wu Y, et al. Tracking T-cells in vivo with a new nanosized MRI contrast agent. Nanomedicine, 2012, 8(8):1345-1354.
20. Johansson L, Johnsson C, Penno E, et al. Acute cardiac transplant rejection:detection and grading with MR imaging with a blood pool contrast agent——experimental study in the rat. Radiology, 2002, 225(1):97-103.
21. Wu YL, Ye Q, Eytn DF, et al. Magnetic resonance imaging investigation of macrophages in acute cardiac allograft rejection after transplantation. Circ Cardiovasc Imaging, 2013, 6(6):965-973.
22. Kurland RJ, West J, Kelley S, et al. Magnetic resonance imaging to detect heart transplant rejection:sensitivity and specificity. Transplant Proc, 1989, 21(1 Pt 3):2537-2543.
23. Walpoth BH, Muller MF, Celik B, et al. Assessment of cardiac rejection by MR imaging and MR-spectroscopy. Eur J Cardiothorac Surg, 1998, 14(4):426-430.
24. Markl M, Rustogi R, Galizia M, et al. Myocardial T2-mapping and velocity mapping:changes in regional left ventricular structure and function afterheart transplantation. Magn Reson Med, 2013, 70(2):517-526.
25. Flögel U, Su S, Kreideweiss I, et al. Noninvasive detection of graft rejection by in vivo (19)F MRI in the early stage. Am J Transplant, 2011, 11(2):235-244.
26. Butler CR, Thompson R, Haykowsky M, et al. Cardiovascular magnetic resonance in the diagnosis of acute heart transplant rejection:a review. J Cardiovasc Magn Reson, 2009, 11:7.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Diagnosis and Monitoring of Acute Heart Transplant Rejection with Cardiovascular Magnetic Resonance

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