Patrizia Pedrotti1, Claudia Vittori1,2, Rita Facchetti3, Stefano Pedretti4, Santo Dellegrottaglie1, Angela Milazzo1, Maria Frigerio2, Manlio Cipriani2, Cristina Giannattasio3,5, Alberto Roghi1, Ornella Rimoldi6,7. 1. CMR Unit, Department of Cardiology and Cardiovascular Surgery, Niguarda Ca' Granda Hospital, Milan, Italy. 2. Heart Transplant Unit, Cardiology 2 Cardiovascular Department, Niguarda Ca' Granda Hospital, Milan, Italy. 3. Health Science Department, Bicocca University, Milan, Italy. 4. Cardiology 3, Cardiovascular Department, Niguarda Ca' Granda Hospital, Milan, Italy. 5. Cardiology 4, Cardiovascular Department, Niguarda Ca' Granda Hospital, Milan, Italy. 6. CNR IBFM, Segrate, Italy rimoldi.ornella@hsr.it. 7. Cardiac Thoracic and Vascular Department, IRCCS Ospedale San Raffaele, Milan, Italy.
Abstract
AIMS: The aim of the present study was to assess the association of the presence and amount of late gadolinium enhancement (LGE) at cardiac magnetic resonance (CMR) with cardiovascular adverse events in patients with orthotopic heart transplantation (HTx). METHODS AND RESULTS: We enrolled 48 patients (mean age, 54.7 ± 14.6 years; 37 men) at various stages after HTx. All patients underwent standard CMR at 1.5 T, to characterize both cardiac anatomy and LGE. Late gadolinium enhancement was detected in 26 patients (54%). All-cause and cardiovascular mortalities, and a composite of major adverse cardiovascular events (MACE) recurrence were evaluated during the follow-up period for a median of 5.16 years. Ten patients (21%) died and 26 (54%) were readmitted because of MACE. Multivariate Cox analysis identified as independent predictors of MACE a diagnosis of cardiac allograft vasculopathy (CAV) (HR 3.63; 1.5-8.7 95% CI; P = 0.0039), left ventricular end systolic volume index (HR 1.04; 95% CI 1.01-1.079; P = 0.008), LGE mass (HR 1.04; 1.01-1.06 95% CI; P = 0.0007), LGE % of left ventricular mass (HR 1.083; 1.03-1.13 95% CI; P = 0.0002). Independent predictors of all-cause death were CAV (HR 6.33; 95% CI 1.33-30.03; P = 0.0201), LGE mass (HR 1.04; 1.01-1.07 95% CI; P = 0.005), LGE % of left ventricular mass (HR 1.075; 1.02-1.13 95% CI; P = 0.007). Patients with CAV had a risk of MACE by 5 years of 67% (95% CI 0.309-0.851%); the addition of 7.9 LGE % to the risk model increased the predicted risk to 88% (95% CI 0.572-0.967%). CONCLUSIONS: The current study demonstrated that the presence of CAV and the total amount of LGE have a significant independent association with MACE and mortality in HTx patients. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: The aim of the present study was to assess the association of the presence and amount of late gadolinium enhancement (LGE) at cardiac magnetic resonance (CMR) with cardiovascular adverse events in patients with orthotopic heart transplantation (HTx). METHODS AND RESULTS: We enrolled 48 patients (mean age, 54.7 ± 14.6 years; 37 men) at various stages after HTx. All patients underwent standard CMR at 1.5 T, to characterize both cardiac anatomy and LGE. Late gadolinium enhancement was detected in 26 patients (54%). All-cause and cardiovascular mortalities, and a composite of major adverse cardiovascular events (MACE) recurrence were evaluated during the follow-up period for a median of 5.16 years. Ten patients (21%) died and 26 (54%) were readmitted because of MACE. Multivariate Cox analysis identified as independent predictors of MACE a diagnosis of cardiac allograft vasculopathy (CAV) (HR 3.63; 1.5-8.7 95% CI; P = 0.0039), left ventricular end systolic volume index (HR 1.04; 95% CI 1.01-1.079; P = 0.008), LGE mass (HR 1.04; 1.01-1.06 95% CI; P = 0.0007), LGE % of left ventricular mass (HR 1.083; 1.03-1.13 95% CI; P = 0.0002). Independent predictors of all-cause death were CAV (HR 6.33; 95% CI 1.33-30.03; P = 0.0201), LGE mass (HR 1.04; 1.01-1.07 95% CI; P = 0.005), LGE % of left ventricular mass (HR 1.075; 1.02-1.13 95% CI; P = 0.007). Patients with CAV had a risk of MACE by 5 years of 67% (95% CI 0.309-0.851%); the addition of 7.9 LGE % to the risk model increased the predicted risk to 88% (95% CI 0.572-0.967%). CONCLUSIONS: The current study demonstrated that the presence of CAV and the total amount of LGE have a significant independent association with MACE and mortality in HTx patients. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Kongkiat Chaikriangkrai; Muhannad Aboud Abbasi; Roberto Sarnari; Daniel Lee; Allen S Anderson; Kambiz Ghafourian; Sadiya S Khan; Esther E Vorovich; Jonathan D Rich; Jane E Wilcox; Julie A Blaisdell; Clyde W Yancy; James Carr; Michael Markl Journal: JACC Cardiovasc Imaging Date: 2019-07-17
Authors: Kongkiat Chaikriangkrai; Muhannad Aboud Abbasi; Roberto Sarnari; Ryan Dolan; Daniel Lee; Allen S Anderson; Kambiz Ghafourian; Sadiya S Khan; Esther E Vorovich; Jonathan D Rich; Jane E Wilcox; Julie A Blaisdell; Clyde W Yancy; James Carr; Michael Markl Journal: JACC Cardiovasc Imaging Date: 2020-03-18