Native T 1 Mapping in the Diagnosis of Cardiac Allograft Rejection: A Prospective Histologically Validated Study

JACC Cardiovasc Imaging. 2019 Aug;12(8 Pt 2):1618-1628. doi: 10.1016/j.jcmg.2018.10.027. Epub 2019 Jan 16.

Abstract

Objectives: This study aimed to determine the role of T1 mapping in identifying cardiac allograft rejection.

Background: Endomyocardial biopsy (EMBx), the current gold standard to diagnose cardiac allograft rejection, is associated with potentially serious complications. Cardiac magnetic resonance (CMR)-based T1 mapping detects interstitial edema and fibrosis, which are important markers of acute and chronic rejection. Therefore, T1 mapping can potentially diagnose cardiac allograft rejection noninvasively.

Methods: Patients underwent CMR within 24 h of EMBx. T1 maps were acquired at 1.5-T. EMBx-determined rejection was graded according to International Society of Heart and Lung Transplant (ISHLT) criteria.

Results: Of 112 biopsies with simultaneous CMR, 60 were classified as group 0 (ISHLT grade 0), 35 as group 1 (ISHLT grade 1R), and 17 as group 2 (2R, 3R, clinically diagnosed rejection, antibody-mediated rejection). Native T1 values in patients with grade 0 biopsies and left ventricular ejection fraction >60% (983 ± 42 ms; 95% confidence interval: 972 to 994 ms) were comparable to values in nontransplant healthy control subjects (974 ± 45 ms; 95% confidence interval: 962 to 987 ms). T1 values were significantly higher in group 2 (1,066 ± 78 ms) versus group 0 (984 ± 42 ms; p = 0.0001) and versus group 1 (1,001 ± 54 ms; p = 0.001). After excluding patients with an estimated glomerular filtration rate <50 ml/min/m2, there was a moderate correlation of log-transformed native T1 with high-sensitivity troponin T (r = 0.54, p < 0.0001) and pro-B-type natriuretic peptide (r = 0.67, p < 0.0001). Using a T1 cutoff value of 1,029 ms, the sensitivity, specificity, and negative predictive value were 93%, 79%, and 99%, respectively.

Conclusions: Myocardial tissue characterization with T1 mapping displays excellent negative predictive capacity for the noninvasive detection of cardiac allograft rejection and holds promise to reduce substantially the EMBx requirement in cardiac transplant rejection surveillance.

Keywords: CMR; EMBx; T(1) mapping; cardiac magnetic resonance; cardiac transplantation; endomyocardial biopsy.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't
  • Validation Study

MeSH terms

  • Adult
  • Allografts
  • Biopsy
  • Case-Control Studies
  • Cross-Sectional Studies
  • Edema, Cardiac / diagnostic imaging*
  • Edema, Cardiac / immunology
  • Edema, Cardiac / pathology
  • Edema, Cardiac / physiopathology
  • Female
  • Fibrosis
  • Graft Rejection / diagnostic imaging*
  • Graft Rejection / immunology
  • Graft Rejection / pathology
  • Graft Rejection / physiopathology
  • Heart Transplantation / adverse effects*
  • Humans
  • Magnetic Resonance Imaging, Cine*
  • Male
  • Middle Aged
  • Myocardium / immunology
  • Myocardium / pathology
  • Predictive Value of Tests
  • Prospective Studies
  • Stroke Volume
  • Treatment Outcome
  • Ventricular Function, Left
  • Young Adult