Clinical Heart TransplantationLeft ventricular function and mass after orthotopic heart transplantation: a comparison of cardiovascular magnetic resonance with echocardiography
Section snippets
Patients and methods
We prospectively acquired 51 sets of CMR and echo data from 21 patients who had undergone orthotopic heart transplantation. The average time between CMR and echo was 0 ± 7 days. The time between each set of CMR–echo data acquisition was 5.0 ± 4.1 months. At the time of scanning, no patient had evidence of rejection on cardiac biopsy. The Royal Brompton and Harefield Hospital ethics committee approved the protocol, and all subjects gave written consent.
Reproducibility of CMR
The results are presented in Table I. We found no significant difference in the EF measured twice by the same observer (mean EF = 71% ± 7%, mean difference = −0.3% ± 2.2%), or by 2 different observers (mean EF = 70% ± 7%, mean difference = 0.4% ± 2%). Furthermore, the limits of agreement were narrow (−4.7% to 4 % and −3.6% to 4.4%, respectively).
The reproducibility of LV mass was also good with no significant difference in the mass measured twice by the same observer (mean mass = 205 ± 41 g,
Discussion
The main findings of this study are that CMR is feasible in the heart transplant population and that it provides highly reproducible measurements of left ventricular EF and mass. Furthermore, echo measurements showed poor agreement with CMR. Cardiovascular magnetic resonance, but not echo, was able to detect small changes over time in EF and mass.
Cardiovascular magnetic resonance offers a reproducible measure of ventricular function and mass that is not dependent on suitable acoustic windows
Conclusion
We have demonstrated that fast acquisition CMR is reproducible in recipients of transplanted hearts and found poor agreement with the M-mode echo measurements routinely used to assess LV function and mass. The highly reproducible results of CMR may allow early detection of changes that occur during graft rejection and provide an accurate assessment of long-term remodeling related to post-transplant hypertension and drug therapy.
Acknowledgements
Dr. N. Bellenger is supported by a grant from SmithKline Beecham, through the National Heart and Lung Institute, Imperial College, London, United Kingdom. This study was supported by the Wellcome Trust and Corda, the heart charity.
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2010, Journal of Heart and Lung TransplantationCitation Excerpt :Our current study substantially extends these data. Cardiac MRI was used to assess LV mass and geometry, and cardiac MRI has been shown to have greater accuracy for these purposes than echocardiography.37 With more accurate assessments of LV volume and wall thickness, we were able to demonstrate that a concentric—and not eccentric phenotype—was associated with adverse outcome.
Assessment of left ventricular function with single breath-hold highly accelerated cine MRI combined with guide-point modeling
2010, European Journal of RadiologyCitation Excerpt :Moreover, cine MRI is considered superior to computed tomography and conventional angiographic volumetric analysis [17–19,23] due to its better spatial resolution, the absence of radiation or other harmful side effects. As a result, cardiac MRI has established as the gold standard for estimation of LV function [2–7]. Till the implementation of SSFP sequences mainly fast low angle shot (FLASH) sequences were used for qualitative and quantitative analyses of LV function [7]; to date, standard 2D cine SSFP sequences are regarded as the standard of reference for volumetric measurements [7].
The Role of Multimodality Cardiac Imaging in the Transplanted Heart
2009, JACC: Cardiovascular ImagingCitation Excerpt :These quantitative echocardiographic techniques of regional and global myocardial function show promise to identify subclinical LV dysfunction in a small number of cardiac transplant recipients and need further validation in larger studies. Although many transplant centers use echocardiography to detect cardiac allograft systolic dysfunction in the setting of cardiac rejection, CMR enables imaging throughout the cardiac cycle and provides excellent spatial resolution to accurately measure diastolic and systolic volumes and hence left and right ventricular ejection fractions (24) (Fig. 4). CMR may also be useful in the detection of ACR by its ability to quantitate changes in myocardial mass (25) or more specifically to detect myocardial edema.