Diagnostic and Prognostic Value of Myocardial Extracellular Volume Fraction Assessed Using Cardiovascular Magnetic Resonance in Patients With Restrictive Cardiac Allograft Physiology

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation Pub Date : 2025-09-18 DOI:10.1111/ctr.70319

Masaki Tsuji, Michelle M. Kittleson, David H. Chang, Evan P. Kransdorf, Andriana P. Nikolova, Lily K. Stern, Mason Lee, Jon A. Kobashigawa

{"title":"Diagnostic and Prognostic Value of Myocardial Extracellular Volume Fraction Assessed Using Cardiovascular Magnetic Resonance in Patients With Restrictive Cardiac Allograft Physiology","authors":"Masaki Tsuji, Michelle M. Kittleson, David H. Chang, Evan P. Kransdorf, Andriana P. Nikolova, Lily K. Stern, Mason Lee, Jon A. Kobashigawa","doi":"10.1111/ctr.70319","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background</h3>\n \n <p>Restrictive cardiac allograft physiology (RCP) is associated with poor prognosis following heart transplantation (HT). While cardiac magnetic resonance (CMR) is useful for evaluating HT recipients, its utility for RCP assessment remains unknown. This study aimed to investigate the diagnostic and prognostic value of CMR in patients with RCP.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>Seventy-five HT recipients (median age: 54 [interquartile range (IQR), 40–63] years; 33.3% female) who underwent contrast-enhanced CMR between 2015 and 2023 were included. Patients were grouped by RCP status (RCP<sup>+</sup> group, <i>n</i> = 30; and RCP<sup>−</sup> group, <i>n</i> = 45). RCP was defined according to the International Society for Heart and Lung Transplantation guidelines. The primary endpoints were all-cause mortality or redo HT.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>The median HT-to-CMR time was 4.6 (IQR, 1.2–11.0) years. Compared to that of the RCP<sup>−</sup> group, the RCP<sup>+</sup> group exhibited significantly higher myocardial T2 (53.1 ± 7.5 vs. 49.7 ± 5.7 ms; <i>p</i> = 0.035) and extracellular volume fraction (ECV) (33.4 ± 6.8% vs. 28.6 ± 6.1%; <i>p</i> = 0.003) values. Multivariate logistic regression analyses revealed an independent association between ECV and RCP (odds ratio = 1.11; 95% CI: 1.02–1.23; <i>p</i> = 0.032). The area under the receiver operating characteristic curve for ECV was 0.73, with 60.7% sensitivity and 83.3% specificity at a cutoff value of 31.5%. After ECV-dependent stratification of patients with RCP, Kaplan–Meier analysis demonstrated significantly higher incidences of primary endpoints in the ECV ≥ 31.5% subgroup than in the ECV < 31.5% subgroup (<i>p</i> = 0.048).</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>CMR-derived myocardial ECV provides both diagnostic and prognostic value in patients with RCP and may potentially help guide the timing for consideration of re-HT.</p>\n </section>\n </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 9","pages":""},"PeriodicalIF":1.9000,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Transplantation","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/ctr.70319","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"SURGERY","Score":null,"Total":0}

引用次数: 0

Abstract

Background

Restrictive cardiac allograft physiology (RCP) is associated with poor prognosis following heart transplantation (HT). While cardiac magnetic resonance (CMR) is useful for evaluating HT recipients, its utility for RCP assessment remains unknown. This study aimed to investigate the diagnostic and prognostic value of CMR in patients with RCP.

Methods

Seventy-five HT recipients (median age: 54 [interquartile range (IQR), 40–63] years; 33.3% female) who underwent contrast-enhanced CMR between 2015 and 2023 were included. Patients were grouped by RCP status (RCP⁺ group, n = 30; and RCP⁻ group, n = 45). RCP was defined according to the International Society for Heart and Lung Transplantation guidelines. The primary endpoints were all-cause mortality or redo HT.

Results

The median HT-to-CMR time was 4.6 (IQR, 1.2–11.0) years. Compared to that of the RCP⁻ group, the RCP⁺ group exhibited significantly higher myocardial T2 (53.1 ± 7.5 vs. 49.7 ± 5.7 ms; p = 0.035) and extracellular volume fraction (ECV) (33.4 ± 6.8% vs. 28.6 ± 6.1%; p = 0.003) values. Multivariate logistic regression analyses revealed an independent association between ECV and RCP (odds ratio = 1.11; 95% CI: 1.02–1.23; p = 0.032). The area under the receiver operating characteristic curve for ECV was 0.73, with 60.7% sensitivity and 83.3% specificity at a cutoff value of 31.5%. After ECV-dependent stratification of patients with RCP, Kaplan–Meier analysis demonstrated significantly higher incidences of primary endpoints in the ECV ≥ 31.5% subgroup than in the ECV < 31.5% subgroup (p = 0.048).

Conclusions

CMR-derived myocardial ECV provides both diagnostic and prognostic value in patients with RCP and may potentially help guide the timing for consideration of re-HT.

查看原文本刊更多论文

心血管磁共振评价心肌细胞外体积分数对限制性异体心脏移植患者的诊断和预后价值。

背景：限制性同种异体心脏移植生理（RCP）与心脏移植（HT）后不良预后相关。虽然心脏磁共振（CMR）可用于评估HT受体，但其对RCP评估的效用尚不清楚。本研究旨在探讨CMR对RCP患者的诊断和预后价值。方法：75例HT患者(中位年龄：54[四分位间距（IQR）， 40-63]岁；包括2015年至2023年间接受对比增强CMR的患者（33.3%女性）。按RCP状态分组（RCP+组30例，RCP-组45例）。RCP是根据国际心肺移植学会指南定义的。主要终点是全因死亡率或重做HT。结果：HT-to-CMR的中位时间为4.6 （IQR, 1.2-11.0）年。与RCP-组相比，RCP+组心肌T2（53.1±7.5 ms比49.7±5.7 ms, p = 0.035）和细胞外体积分数（ECV）（33.4±6.8%比28.6±6.1%,p = 0.003）显著升高。多因素logistic回归分析显示ECV和RCP之间存在独立关联（优势比= 1.11;95% CI: 1.02-1.23; p = 0.032）。ECV的受试者工作特征曲线下面积为0.73，灵敏度为60.7%，特异性为83.3%，截止值为31.5%。对RCP患者进行ECV依赖性分层后，Kaplan-Meier分析显示，ECV≥31.5%亚组的主要终点发生率显著高于ECV < 31.5%亚组（p = 0.048）。结论：cmr衍生的心肌ECV对RCP患者具有诊断和预后价值，并可能有助于指导考虑re-HT的时机。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Clinical Transplantation 医学-外科

CiteScore

3.70

自引率

4.80%

发文量

286

审稿时长

2 months

期刊介绍： Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored. Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include: Immunology and immunosuppression; Patient preparation; Social, ethical, and psychological issues; Complications, short- and long-term results; Artificial organs; Donation and preservation of organ and tissue; Translational studies; Advances in tissue typing; Updates on transplant pathology;. Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries. Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.