Abstract 11627: Coronary Enhancement as Assessed by Contrast-Enhanced Cardiac MRI in Pediatric Heart Recipients with Angiographic Transplant Coronary Artery Disease
Introduction: Recurrent invasive coronary angiography remains the standard method for surveillance for transplant coronary artery disease (TCAD). Contrast enhanced arterial magnetic resonance imaging (CE-CMR) has been used to identify vascular inflammation. We hypothesized that the presence of coronary enhancement evaluated by CE-CMR differs between pediatric heart transplant recipients with and without angiographically detectable TCAD (ATCAD).
Methods: 29 pediatric heart recipients undergoing surveillance coronary angiography and 8 healthy volunteers (controls) were studied with CE-CMR using a T1 weighted 3-dimensional gradient echo inversion recovery sequence and gadolinium performed within a median of 1 day of angiography. Left ventricular (LV) ejection fraction (EF) and myocardial scar were assessed. Contrast to noise ratio (CNR) for coronary wall relative to aortic blood was determined. ATCAD was graded semiquantitatively by Pediatric Heart Transplant Study criteria by an observer blinded to CE-CMR data.
Results: 6 transplant recipients demonstrated ATCAD- 3 (moderate), 2 (mild), 1 (severe). LV EF was significantly poorer in subjects with ATCAD (62.2%, interquartile range (IQR)=60.6-70.9%) vs no ATCAD (75.3%, IQR=70.4-78.8%; p=0.008) vs controls (72.9%, IQR=68.7-74.9%; p=0.008). ATCAD subjects had greater brain natriuretic peptide levels (p=0.027). Myocardial scar was observed in 2 subjects, both with ATCAD. Subjects with ATCAD demonstrated greater coronary artery wall enhancement (15.74±13.30) compared to subjects with no ATCAD (6.64±5.55, p=0.015) and controls (2.78±1.92, p=0.001). Subjects with no ATCAD had greater coronary wall enhancement than controls (p<0.001).
Conclusion: CE-CMR showed more intense coronary wall enhancement in pediatric heart transplant recipients with TCAD compared to recipients without TCAD demonstrating the potential for CE-CMR to noninvasively identify angiographic detectable TCAD.
- © 2012 by American Heart Association, Inc.