Utilizing cardiac magnetic resonance to assess the sequelae of prior rejection episodes on myocardium and correlation with clinical outcomes

JHLT Open Pub Date : 2025-05-24 DOI:10.1016/j.jhlto.2025.100298

Akila Bersali MD , Farhan Ishaq MD, MPH, MBA , Mianli Xiao PhD , Edward A Graviss PhD, MPH , George Naufal , Ashrith Guha MD, MPH , Dipan J. Shah MD , Rayan Yousefzai MD

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Abstract

This study compared structural and functional alterations using cardiac MRI (CMR) in heart transplant recipients with and without acute cellular rejection (ACR) and analyzed their association with clinical outcomes. ACR patients showed reduced left ventricular global longitudinal strain (LV GLS) (10% vs 12%; P = 0.03), reduced right ventricular global longitudinal strain (16% vs 18%; P = 0.04), increased left ventricular (LV) mass (72 vs 61 g/m²; P = 0.003), and decreased right ventricular stroke volume (70 vs 79 mL; P = 0.05). Univariate analysis revealed that LV ejection fraction (EF) (HR 0.90, P < 0.001), RV ejection fraction (HR 0.91, P = 0.004), LV stroke volume (SV) (HR 0.96, P = 0.01), RV SV (HR 0.96, P = 0.003), and LV scar size (HR 1.13, P = 0.002) were significantly associated with cardiovascular hospitalization or mortality. After adjusting for relevant covariates, indexed RV SV (HR 0.90, P = 0.015) and LV scar size (HR 1.17, P = 0.026) remained significant predictors of the clinical outcome. CMR can identify sequelae of ACR, potentially influencing clinical decisions.

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应用心脏磁共振评价既往排斥事件对心肌的后遗症及其与临床预后的相关性

本研究使用心脏MRI （CMR）比较了有和没有急性细胞排斥反应（ACR）的心脏移植受者的结构和功能改变，并分析了它们与临床结果的关系。ACR患者显示左心室整体纵向应变（LV GLS）降低(10% vs 12%；P = 0.03)，右心室整体纵向应变降低(16% vs 18%；P = 0.04)，左室（LV）质量增加(72 vs 61 g/m²；P = 0.003)，右心室卒中容量减少(70 vs 79 mL；p = 0.05)。单因素分析显示左室射血分数（EF） (HR 0.90, P <；0.001)、左室射血分数（HR 0.91, P = 0.004）、左室卒中容量（SV）（HR 0.96, P = 0.01）、左室SV （HR 0.96, P = 0.003）和左室疤痕大小（HR 1.13, P = 0.002）与心血管住院或死亡率显著相关。在校正相关协变量后，指数RV SV （HR 0.90, P = 0.015）和左室疤痕大小（HR 1.17, P = 0.026）仍然是临床结局的显著预测因子。CMR可以识别ACR的后遗症，可能影响临床决策。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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JHLT Open

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