Reduced myocardial perfusion reserve and transmural perfusion gradient in heart transplant arteriopathy assessed by magnetic resonance imaging

Olaf M. Muehling, Norbert M. Wilke, Prasad Panse, Michael Jerosch-Herold, Betsy V. Wilson, Robert F. Wilson, Leslie W. Miller

Research output: Contribution to journalArticle

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Abstract

OBJECTIVES: The goal of this study was to detect transplant arteriopathy (Tx-CHD) by a reduced myocardial perfusion reserve (MPR) and resting endomyocardial/epimyocardial perfusion ratio (Endo/Epi ratio). BACKGROUND: Transplant arteriopathy often lacks clinical symptoms and is the reason for frequent surveillance angiography in heart transplant (Tx) recipients. Magnetic resonance perfusion imaging (MRPI) allows noninvasive assessment of transmural and selective endomyocardial and epimyocardial perfusion. METHODS: Fifteen healthy volunteers (controls) and three groups (A, B, C) of Tx recipients were included. In controls and patients, MPR (hyperemic/resting perfusion) and Endo/Epi ratio were determined with MRPI after injection of gadolinium-diethylenetriamine pentaacetic acid at rest and during hyperemia (intravenous adenosine). Group A (n = 10) had no left ventricular (LV) hypertrophy and/or prior rejection, while patients in group B (n = 10) had at least one of these characteristics. Patients in group A and B had a normal coronary angiogram and a coronary flow reserve (CFR) of ≥2.5 (CFR = hyperemic/resting blood flow). Group C (n = 7) had Tx-CHD diagnosed by angiography and a reduced CFR (<2.5). RESULTS: In group C, MPR (1.7 ± 0.5) and Endo/Epi ratio (1.1 ± 0.2) were significantly reduced compared with controls (4.2 ± 0.7 and 1.6 ± 0.3; both p < 0.0001), group A (3.6 ± 0.7 and 1.6 ± 0.2; both p < 0.0001) and B (2.7 ± 0.9, p < 0.01 and 1.4 ± 0.1, p < 0.04). Transplant arteriopathy can be excluded by an MPR of >2.3 with sensitivity and specificity of 100% and 85%. If LV hypertrophy and prior rejection are excluded, Tx-CHD can be excluded by an Endo/Epi ratio of >1.3 with 100% and 80%. CONCLUSIONS: Magnetic resonance perfusion imaging detects Tx-CHD by a decreased MPR. After exclusion of LV hypertrophy and prior rejection, resting Endo/Epi ratio alone might be sufficient to indicate Tx-CHD.

Original languageEnglish (US)
Pages (from-to)1054-1060
Number of pages7
JournalJournal of the American College of Cardiology
Volume42
Issue number6
DOIs
StatePublished - Sep 17 2003
Externally publishedYes

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Perfusion
Magnetic Resonance Imaging
Transplants
Magnetic Resonance Angiography
Left Ventricular Hypertrophy
Angiography
Pentetic Acid
Hyperemia
Gadolinium
Adenosine
Healthy Volunteers
Sensitivity and Specificity
Control Groups
Injections

ASJC Scopus subject areas

  • Nursing(all)

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Reduced myocardial perfusion reserve and transmural perfusion gradient in heart transplant arteriopathy assessed by magnetic resonance imaging. / Muehling, Olaf M.; Wilke, Norbert M.; Panse, Prasad; Jerosch-Herold, Michael; Wilson, Betsy V.; Wilson, Robert F.; Miller, Leslie W.

In: Journal of the American College of Cardiology, Vol. 42, No. 6, 17.09.2003, p. 1054-1060.

Research output: Contribution to journalArticle

Muehling, Olaf M. ; Wilke, Norbert M. ; Panse, Prasad ; Jerosch-Herold, Michael ; Wilson, Betsy V. ; Wilson, Robert F. ; Miller, Leslie W. / Reduced myocardial perfusion reserve and transmural perfusion gradient in heart transplant arteriopathy assessed by magnetic resonance imaging. In: Journal of the American College of Cardiology. 2003 ; Vol. 42, No. 6. pp. 1054-1060.
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title = "Reduced myocardial perfusion reserve and transmural perfusion gradient in heart transplant arteriopathy assessed by magnetic resonance imaging",
abstract = "OBJECTIVES: The goal of this study was to detect transplant arteriopathy (Tx-CHD) by a reduced myocardial perfusion reserve (MPR) and resting endomyocardial/epimyocardial perfusion ratio (Endo/Epi ratio). BACKGROUND: Transplant arteriopathy often lacks clinical symptoms and is the reason for frequent surveillance angiography in heart transplant (Tx) recipients. Magnetic resonance perfusion imaging (MRPI) allows noninvasive assessment of transmural and selective endomyocardial and epimyocardial perfusion. METHODS: Fifteen healthy volunteers (controls) and three groups (A, B, C) of Tx recipients were included. In controls and patients, MPR (hyperemic/resting perfusion) and Endo/Epi ratio were determined with MRPI after injection of gadolinium-diethylenetriamine pentaacetic acid at rest and during hyperemia (intravenous adenosine). Group A (n = 10) had no left ventricular (LV) hypertrophy and/or prior rejection, while patients in group B (n = 10) had at least one of these characteristics. Patients in group A and B had a normal coronary angiogram and a coronary flow reserve (CFR) of ≥2.5 (CFR = hyperemic/resting blood flow). Group C (n = 7) had Tx-CHD diagnosed by angiography and a reduced CFR (<2.5). RESULTS: In group C, MPR (1.7 ± 0.5) and Endo/Epi ratio (1.1 ± 0.2) were significantly reduced compared with controls (4.2 ± 0.7 and 1.6 ± 0.3; both p < 0.0001), group A (3.6 ± 0.7 and 1.6 ± 0.2; both p < 0.0001) and B (2.7 ± 0.9, p < 0.01 and 1.4 ± 0.1, p < 0.04). Transplant arteriopathy can be excluded by an MPR of >2.3 with sensitivity and specificity of 100{\%} and 85{\%}. If LV hypertrophy and prior rejection are excluded, Tx-CHD can be excluded by an Endo/Epi ratio of >1.3 with 100{\%} and 80{\%}. CONCLUSIONS: Magnetic resonance perfusion imaging detects Tx-CHD by a decreased MPR. After exclusion of LV hypertrophy and prior rejection, resting Endo/Epi ratio alone might be sufficient to indicate Tx-CHD.",
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T1 - Reduced myocardial perfusion reserve and transmural perfusion gradient in heart transplant arteriopathy assessed by magnetic resonance imaging

AU - Muehling, Olaf M.

AU - Wilke, Norbert M.

AU - Panse, Prasad

AU - Jerosch-Herold, Michael

AU - Wilson, Betsy V.

AU - Wilson, Robert F.

AU - Miller, Leslie W.

PY - 2003/9/17

Y1 - 2003/9/17

N2 - OBJECTIVES: The goal of this study was to detect transplant arteriopathy (Tx-CHD) by a reduced myocardial perfusion reserve (MPR) and resting endomyocardial/epimyocardial perfusion ratio (Endo/Epi ratio). BACKGROUND: Transplant arteriopathy often lacks clinical symptoms and is the reason for frequent surveillance angiography in heart transplant (Tx) recipients. Magnetic resonance perfusion imaging (MRPI) allows noninvasive assessment of transmural and selective endomyocardial and epimyocardial perfusion. METHODS: Fifteen healthy volunteers (controls) and three groups (A, B, C) of Tx recipients were included. In controls and patients, MPR (hyperemic/resting perfusion) and Endo/Epi ratio were determined with MRPI after injection of gadolinium-diethylenetriamine pentaacetic acid at rest and during hyperemia (intravenous adenosine). Group A (n = 10) had no left ventricular (LV) hypertrophy and/or prior rejection, while patients in group B (n = 10) had at least one of these characteristics. Patients in group A and B had a normal coronary angiogram and a coronary flow reserve (CFR) of ≥2.5 (CFR = hyperemic/resting blood flow). Group C (n = 7) had Tx-CHD diagnosed by angiography and a reduced CFR (<2.5). RESULTS: In group C, MPR (1.7 ± 0.5) and Endo/Epi ratio (1.1 ± 0.2) were significantly reduced compared with controls (4.2 ± 0.7 and 1.6 ± 0.3; both p < 0.0001), group A (3.6 ± 0.7 and 1.6 ± 0.2; both p < 0.0001) and B (2.7 ± 0.9, p < 0.01 and 1.4 ± 0.1, p < 0.04). Transplant arteriopathy can be excluded by an MPR of >2.3 with sensitivity and specificity of 100% and 85%. If LV hypertrophy and prior rejection are excluded, Tx-CHD can be excluded by an Endo/Epi ratio of >1.3 with 100% and 80%. CONCLUSIONS: Magnetic resonance perfusion imaging detects Tx-CHD by a decreased MPR. After exclusion of LV hypertrophy and prior rejection, resting Endo/Epi ratio alone might be sufficient to indicate Tx-CHD.

AB - OBJECTIVES: The goal of this study was to detect transplant arteriopathy (Tx-CHD) by a reduced myocardial perfusion reserve (MPR) and resting endomyocardial/epimyocardial perfusion ratio (Endo/Epi ratio). BACKGROUND: Transplant arteriopathy often lacks clinical symptoms and is the reason for frequent surveillance angiography in heart transplant (Tx) recipients. Magnetic resonance perfusion imaging (MRPI) allows noninvasive assessment of transmural and selective endomyocardial and epimyocardial perfusion. METHODS: Fifteen healthy volunteers (controls) and three groups (A, B, C) of Tx recipients were included. In controls and patients, MPR (hyperemic/resting perfusion) and Endo/Epi ratio were determined with MRPI after injection of gadolinium-diethylenetriamine pentaacetic acid at rest and during hyperemia (intravenous adenosine). Group A (n = 10) had no left ventricular (LV) hypertrophy and/or prior rejection, while patients in group B (n = 10) had at least one of these characteristics. Patients in group A and B had a normal coronary angiogram and a coronary flow reserve (CFR) of ≥2.5 (CFR = hyperemic/resting blood flow). Group C (n = 7) had Tx-CHD diagnosed by angiography and a reduced CFR (<2.5). RESULTS: In group C, MPR (1.7 ± 0.5) and Endo/Epi ratio (1.1 ± 0.2) were significantly reduced compared with controls (4.2 ± 0.7 and 1.6 ± 0.3; both p < 0.0001), group A (3.6 ± 0.7 and 1.6 ± 0.2; both p < 0.0001) and B (2.7 ± 0.9, p < 0.01 and 1.4 ± 0.1, p < 0.04). Transplant arteriopathy can be excluded by an MPR of >2.3 with sensitivity and specificity of 100% and 85%. If LV hypertrophy and prior rejection are excluded, Tx-CHD can be excluded by an Endo/Epi ratio of >1.3 with 100% and 80%. CONCLUSIONS: Magnetic resonance perfusion imaging detects Tx-CHD by a decreased MPR. After exclusion of LV hypertrophy and prior rejection, resting Endo/Epi ratio alone might be sufficient to indicate Tx-CHD.

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