Abstract
Late gadolinium enhancement (LGE) on cardiac magnetic resonance imaging has prognostic
utility in populations with cardiac disease, including heart transplant (HT) recipients.
The etiology of specific LGE patterns and their correlation with outcomes after HT
are unclear. Antibody-mediated rejection and cardiac allograft vasculopathy are major
causes of death, and their evaluation remains challenging. We report identical diffuse
subepicardial LGE in 2 highly allosensitized HT recipients who developed allograft
failure. We postulate this LGE pattern may be related to antibody-mediated rejection
and cardiac allograft vasculopathy, and portends poor outcomes. These cases illustrate
a potential role of cardiac magnetic resonance for antibody-mediated rejection evaluation
and risk stratification.
Résumé
Le rehaussement tardif après injection de gadolinium (RTG) observé à l’imagerie cardiaque
par résonance magnétique est utile au pronostic chez les populations atteintes de
cardiopathie, dont les receveurs de transplantation cardiaque (TC). On en connaît
peu sur l’étiologie des aspects particuliers de RTG et leur corrélation avec les résultats
cliniques après la TC. Le rejet médié par anticorps et la vasculopathie d’allogreffe
cardiaque sont les causes principales de décès. Leur évaluation demeure difficile.
Nous rapportons un RTG diffus dans la région sous-épicardique identique chez les 2
receveurs de TC hautement allosensibilisés qui ont développé une insuffisance post-allogreffe.
Nous posons comme postulat que cet aspect de RTG peut être lié au rejet médié par
anticorps et à la vasculopathie d’allogreffe cardiaque, et qu’il laisse présager des
résultats cliniques médiocres. Ces cas montrent le rôle potentiel de l’imagerie cardiaque
par résonance magnétique lors de l’évaluation du rejet médié par anticorps et de la
stratification du risque.
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References
- Prognostic impact of late gadolinium enhancement in the risk stratification of heart transplant patients.Eur Heart J Cardiovasc Imaging. 2017; 18: 130-137
- Late failing heart allografts: pathology of cardiac allograft vasculopathy and association with antibody-mediated rejection.Am J Transplant. 2016; 16: 111-120
- Late gadolinium enhancement in cardiac transplant patients is associated with adverse ventricular functional parameters and clinical outcomes.Can J Cardiol. 2013; 29: 1076-1083
- Late gadolinium enhancement assessed by cardiac magnetic resonance imaging in heart transplant recipients with different stages of cardiac allograft vasculopathy.Eur Heart J Cardiovasc Imaging. 2014; 15: 1125-1132
- Correlation of cardiovascular magnetic resonance imaging findings and endomyocardial biopsy results in patients undergoing screening for heart transplant rejection.J Heart Lung Transplant. 2015; 34: 643-650
Article info
Publication history
Published online: August 23, 2018
Accepted:
August 16,
2018
Received:
May 13,
2018
Footnotes
See page 1687.e7 for disclosure information.
Identification
Copyright
© 2018 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
