Approach to optimal assessment of right ventricular remodelling in heart transplant recipients: insights from myocardial work index, T1 mapping, and endomyocardial biopsy

Autor: Leyla Elif Sade, Ayse Colak, Selin Ardali Duzgun, Tuncay Hazırolan, Atilla Sezgin, Erwan Donal, Steele C Butcher, Handan Özdemir, Bahar Pirat, Serpil Eroglu, Haldun Muderrisoglu
Přispěvatelé: Başkent University Hospital [Adana, Turkey], University of Pittsburgh Medical Center [Pittsburgh, PA, États-Unis] (UPMC), Hacettepe University = Hacettepe Üniversitesi, Laboratoire Traitement du Signal et de l'Image (LTSI), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), Universiteit Leiden, University of Baskent
Rok vydání: 2022
Předmět:
Zdroj: European Heart Journal-Cardiovascular Imaging
European Heart Journal-Cardiovascular Imaging, 2022, ⟨10.1093/ehjci/jeac108⟩
ISSN: 2047-2412
2047-2404
DOI: 10.1093/ehjci/jeac108
Popis: Aims Right ventricular (RV) dysfunction is an important cause of graft failure after heart transplantation (HTx). We sought to investigate relative merits of echocardiographic tools and cardiac magnetic resonance (CMR) with T1 mapping for the assessment of functional adaptation and remodelling of the RV in HTx recipients. Methods and results Sixty-one complete data set of echocardiography, CMR, right heart catheterization, and biopsy were obtained. Myocardial work index (MWI) was quantified by integrating longitudinal strain (LS) with invasively measured pulmonary artery pressure. CMR derived RV volumes, T1 time, and extracellular volume (ECV) were quantified. Endomyocardial biopsy findings were used as the reference standard for myocardial microstructural changes. In HTx recipients who never had a previous allograft rejection, longitudinal function parameters were lower than healthy organ donors, while ejection fraction (EF) (52.0 ± 8.7%) and MWI (403.2 ± 77.2 mmHg%) were preserved. Rejection was characterized by significantly reduced LS, MWI, longer T1 time, and increased ECV that improved after recovery, whereas RV volumes and EF did not change MWI was the strongest determinant of rejection related myocardial damage (area under curve: 0.812, P < 0.0001, 95% CI: 0.69–0.94) with good specificity (77%), albeit modest sensitivity. In contrast, T1 time and ECV were sensitive (84%, both) but not specific to detect subclinical RV damage. Conclusion Subclinical adaptive RV remodelling is characterized by preserved RV EF despite longitudinal function abnormalities, except for MWI. While ultrastructural damage is reflected by MWI, ECV, and T1 time, only MWI has the capability to discriminate functional adaptation from transition to subclinical structural damage.
Databáze: OpenAIRE
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