Abstract 13611: Negative Prognostic Impact of Late Gadolinium Enhancement on Cardiac Magnetic Resonance Images in Heart Transplant Patients
Introduction: Late gadolinium enhancement (LGE) presence and extension on cardiovascular magnetic resonance (CMR) images have been linked to the occurrence of adverse cardiac events or to negative prognostic indicators in a number of different cardiac conditions.
Purpose: To examine whether LGE presence and extension on CMR images predict adverse outcomes in HTX patients (pts).
Methods: The study population consisted of 48 HTX pts (mean age, 54.7±14.6 years; 37 men). HTX rejection requiring specific therapy was documented in 28 pts (58%). HTX coronary artery disease (TCAD) was described in 19 (40%) pts. CMR images were acquired at a mean of 116±62 months after HTX and analyzed for LGE presence and extent (LGE%) and for biventricular ejection fraction. Pts were followed for a composite outcome of hospitalization for heart failure and cardiac death.
Results: Myocardial LGE was detected in 26 (54%) pts; a typical ischemic pattern was observed in 8 pts (TCAD was demonstrated in 6 [75%] of them), the remaining showed non ischemic-related patterns. LGE% showed a significant inverse correlation with left ventricular (Spearman's rho = −0.53, p = 0.0003,) and right ventricular (Spearman's rho = −0.37, p = 0.03) ejection fraction. During a median follow-up of 12.5 months, an index event occurred in 8 (17%) pts (7 with and 1 without LGE; p = 0.0391 for Kaplan-Meier survival curves; Figure 1). At a multivariate analysis including the ischemia time of graft at transplantation, TCAD, previous rejections and LGE% as covariates, only LGE% showed to be independently correlated with event occurrence (hazard ratio for every 1% increase in LGE% = 1.16; 95% C.I. 1.02–1.33; p= 0.026).
Conclusions: At a late post-HTX evaluation by CMR, myocardial LGE is a common finding, more frequently observed with a non-ischemic pattern. Myocardial involvement by LGE at CMR is a significant predictor of adverse cardiac outcomes in HTX pts. Figure 1.Kaplan-Meier event-free survival curve in pts with and without LGE
- © 2010 by American Heart Association, Inc.