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

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.