[go: up one dir, main page]
More Web Proxy on the site http://driver.im/ Skip to main content
Springer Nature Link
Log in

CMR-derived extracellular volume fraction (ECV) in asymptomatic heart transplant recipients: correlations with clinical features and myocardial edema

  • Original Paper
  • Published:
The International Journal of Cardiovascular Imaging Aims and scope Submit manuscript

Abstract

Myocardial interstitial expansion seems to be fundamental to the process of adverse left ventricular remodeling. Recent evidence has shown that the extracellular volume fraction (ECV) derived from cardiovascular magnetic resonance (CMR) can be used as a noninvasive method to quantify myocardial interstitial volume in a range of heart diseases. Our aim was to determine whether ECV is increased in asymptomatic orthotopic heart transplant (HTx) patients and its associations with clinical features and T2 values, the elevation of which usually suggests myocardial edema. A group of asymptomatic cardiac transplant recipients and some healthy volunteers were invited to undergo a comprehensive CMR scan, including cine imaging, late gadolinium enhancement, T1 mapping and T2 mapping, from March to June in 2017. All quantitative measurements were averaged from the basal and mid short-axis slices. Fifty-eight recipients (mean age, 42.7 ± 11.5 years; 13 females), at a median of 1.8 years (0.3–6.3 years) after HTx, and 20 healthy volunteers (mean age, 39.5 ± 11.3 years; 5 females) underwent the CMR scan. We found that both the ECV and T2 values were higher in the post-HTx group (ECV: 26.7 ± 3.3 vs. 24.6 ± 2.5%, p = 0.008; T2: 47.7 ± 2.8 vs. 44.5 ± 1.6 ms, p < 0.001) than in the control group. ECV was moderately associated with organ ischemia time at the time of transplantation but not with the hemodynamics parameter or the time since transplantation at CMR. Additionally, a relatively strong correlation was observed between ECV and T2 (r = 0.7, p < 0.001). So, our conclusion is that CMR-derived ECV is increased and associated with peri-transplant ischemia time in asymptomatic HTx patients. And the strong correlation of ECV with elevated T2 indicates that myocardial edema may be an important part of the extracellular volume expansion after heart transplantation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
£29.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price includes VAT (United Kingdom)

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Abbreviations

ECV:

Extracellular volume fraction

CMR:

Cardiovascular magnetic resonance

HTx:

Heart transplant

LGE:

Late gadolinium enhancement

MF:

Myocardial fibrosis

EMB:

Endomyocardial biopsy

CAV:

Cardiac allograft vasculopathy

ACR:

Acute allograft rejection

CCTA:

Coronary computed tomography angiography

CAG:

Coronary angiography

SSFP:

Cine steady-state free precession

MOLLI:

Modified look-locker inversion recovery

LV:

Left ventricle

LVEF:

LV ejection fraction

LVEDV:

LV end-diastolic volume

LVESV:

LV end-systolic volume

LVM:

LV mass

IVS:

Interventricular septum

RV:

Right ventricle

References

  1. Beltrami CA, Finato N, Rocco M, Feruglio GA, Puricelli C, Cigola E, Quaini F, Sonnenblick EH, Olivetti G, Anversa P (1994) Structural basis of end-stage failure in ischemic cardiomyopathy in humans. Circulation 89(1):151–163. https://doi.org/10.1161/01.cir.89.1.151

    Article  CAS  PubMed  Google Scholar 

  2. Swynghedauw B (1999) Molecular mechanisms of myocardial remodeling. Springer, New York

    Google Scholar 

  3. Moreo A, Ambrosio G, Chiara BD, Pu M, Tran T, Mauri F, Raman SV (2009) Influence of myocardial fibrosis on left ventricular diastolic function noninvasive assessment by cardiac magnetic resonance and echo. Circ Cardiovasc Imaging 2(6):437

    Article  Google Scholar 

  4. Wong TC, Piehler K, Meier CG, Testa SM, Klock AM, Aneizi AA, Shakesprere J, Kellman P, Shroff SG, Schwartzman DS (2012) Association between extracellular matrix expansion quantified by cardiovascular magnetic resonance and short-term mortality. Circulation 126(10):1206

    Article  Google Scholar 

  5. Youn JC, Hong YJ, Lee HJ, Han K, Shim CY, Hong GR, Suh YJ, Hur J, Kim YJ, Choi BW (2017) Contrast-enhanced T1 mapping-based extracellular volume fraction independently predicts clinical outcome in patients with non-ischemic dilated cardiomyopathy: a prospective cohort study. Eur Radiol 27(9):3924–3933

    Article  Google Scholar 

  6. Díez J, Querejeta R, López B, González A, Larman M, Ubago JLM (2002) Losartan-dependent regression of myocardial fibrosis is associated with reduction of left ventricular chamber stiffness in hypertensive patients. Circulation 105(21):2512–2517

    Article  Google Scholar 

  7. Izawa H, Murohara T, Nagata K, Isobe S, Asano H, Amano T, Ichihara S, Kato T, Ohshima S, Murase Y (2005) Mineralocorticoid receptor antagonism ameliorates left ventricular diastolic dysfunction and myocardial fibrosis in mildly symptomatic patients with idiopathic dilated cardiomyopathy: a pilot study. Circulation 112(19):2940

    Article  CAS  Google Scholar 

  8. Moon JC, Messroghli DR, Kellman P, Piechnik SK, Robson MD, Ugander M, Gatehouse PD, Arai AE, Friedrich MG, Neubauer S (2013) Myocardial T1 mapping and extracellular volume quantification: a Society for Cardiovascular Magnetic Resonance (SCMR) and CMR Working Group of the European Society of Cardiology consensus statement. J Cardiovasc Magn Reson 15(1):92

    Article  Google Scholar 

  9. Flett AS, Hayward MP, Ashworth MT, Hansen MS, Taylor AM, Elliott PM, Mcgregor C, Moon JC (2010) Equilibrium contrast cardiovascular magnetic resonance for the measurement of diffuse myocardial fibrosis: preliminary validation in humans. Circulation 122(2):138

    Article  Google Scholar 

  10. Sibley CT, Noureldin RA, Gai N, Nacif MS, Liu S, Turkbey EB, Mudd JO, Rj VDG, Lima JA, Halushka MK (2012) T1 Mapping in cardiomyopathy at cardiac MR: comparison with endomyocardial biopsy. Radiology 265(3):724–732

    Article  Google Scholar 

  11. Miller CA, Naish JH, Bishop P, Coutts G, Clark D, Zhao S, Ray SG, Yonan N, Williams SG, Flett AS (2013) Comprehensive validation of cardiovascular magnetic resonance techniques for the assessment of myocardial extracellular volume. Circ Cardiovasc Imaging 6(4):e25

    Google Scholar 

  12. Diao K, Yang Z, Xu H, Liu X, Zhang Q, Shi K, Jiang L, Xie L, Wen L, Guo Y (2017) Histologic validation of myocardial fibrosis measured by T1 mapping: a systematic review and meta-analysis. J Cardiovasc Magn Reson 18(1):92

    Article  Google Scholar 

  13. Gramley F, Lorenzen J, Pezzella F, Kettering K, Himmrich E, Plumhans C, Koellensperger E, Munzel T (2009) Hypoxia and myocardial remodeling in human cardiac allografts: a time-course study. J Heart Lung Transplant 28(11):1119–1126

    Article  Google Scholar 

  14. Armstrong AT, Binkley PF, Baker PB, Myerowitz PD, Leier CV (1998) Quantitative investigation of cardiomyocyte hypertrophy and myocardial fibrosis over 6 years after cardiac transplantation. J Am Coll Cardiol 32(3):704

    Article  CAS  Google Scholar 

  15. Ide S, Riesenkampff E, Chiasson DA, Dipchand AI, Kantor PF, Chaturvedi RR, Yoo SJ, Grossewortmann L (2017) Histological validation of cardiovascular magnetic resonance T1 mapping markers of myocardial fibrosis in paediatric heart transplant recipients. J Cardiovasc Magn Reson 19(1):10

    Article  Google Scholar 

  16. Feingold B, Salgado CM, Reyes-Múgica M, Drant SE, Miller SA, Kennedy M, Kellman P, Schelbert EB, Wong TC (2017) Diffuse myocardial fibrosis among healthy pediatric heart transplant recipients: correlation of histology, cardiovascular magnetic resonance, and clinical phenotype. Pediatr Transplant 21 (5):e12986. https://doi.org/10.1111/petr.12986

    Article  CAS  Google Scholar 

  17. Miller CA, Sarma J, Naish JH, Yonan N, Williams SG, Shaw SM, Clark D, Pearce K, Stout M, Potluri R, Borg A, Coutts G, Chowdhary S, McCann GP, Parker GJM, Ray SG, Schmitt M (2014) Multiparametric cardiovascular magnetic resonance assessment of cardiac allograft vasculopathy. J Am Coll Cardiol 63(8):799–808. https://doi.org/10.1016/j.jacc.2013.07.119

    Article  PubMed  Google Scholar 

  18. Pickering JG, Boughner DR (1990) Fibrosis in the transplanted heart and its relation to donor ischemic time. Assessment with polarized light microscopy and digital image analysis. Circulation 81(3):949

    Article  CAS  Google Scholar 

  19. Coelho-Filho OR, Shah R, Lavagnoli CFR, Barros JC, Neilan TG, Murthy VL, Oliveira PPMD, Souza JRM (2016) Myocardial tissue remodeling after orthotopic heart transplantation: a pilot cardiac magnetic resonance study. Int J Cardiovasc Imaging 34:15–24

    Article  Google Scholar 

  20. Feingold B, Picarsic J, Lesniak A, Popp BA, Woodtrageser MA, Demetris AJ (2017) Late graft dysfunction after pediatric heart transplantation is associated with fibrosis and microvasculopathy by automated, digital whole-slide analysis. J Heart Lung Transplant 36:1336–1343

    Article  Google Scholar 

  21. Shivraman G, Yiu-Cho C, Ali M, Georgeta M, Sanjay R, Raman SV, Simonetti OP (2009) T2 quantification for improved detection of myocardial edema. J Cardiovasc Magn Reson 11(1):56

    Article  Google Scholar 

  22. Tahir E, Sinn M, Bohnen S, Avanesov M, Säring D, Stehning C, Schnackenburg B, Eulenburg C, Wien J, Radunski UK (2017) Acute versus chronic myocardial infarction: diagnostic accuracy of quantitative native t1 and t2 mapping versus assessment of edema on standard t2-weighted cardiovascular MR images for differentiation. Radiology 285(1):83

    Article  Google Scholar 

  23. Markl M, Rustogi R, Galizia M, Goyal A, Collins J, Usman A, Jung B, Foell D, Carr J (2013) Myocardial T2-mapping and velocity mapping: changes in regional left ventricular structure and function after heart transplantation. Magn Reson Med 70(2):517–526

    Article  Google Scholar 

  24. Miller CA, Naish JH, Shaw SM, Yonan N, Williams SG, Clark D, Ainslie MP, Borg A, Coutts G, Parker GJ (2014) Multiparametric cardiovascular magnetic resonance surveillance of acute cardiac allograft rejection and characterisation of transplantation-associated myocardial injury. J Cardiovasc Magn Reson 16(1):1–11

    Article  CAS  Google Scholar 

  25. Kramer CM, Barkhausen J, Flamm SD, Kim RJ, Nagel E (2013) Standardized cardiovascular magnetic resonance (CMR) protocols 2013 update. J Cardiovasc Magn Reson 15(1):91

    Article  Google Scholar 

  26. Braggion-Santos MF, Andre F, Lossnitzer D, Hofmann E, Simpfendörfer J, Dösch A, Katus HA, Steen H (2014) Prevalence of different forms of infarct-atypical late gadolinium enhancement in patients early and late after heart transplantation. Clin Res Cardiol 103(1):57–63

    Article  CAS  Google Scholar 

  27. Rowan RA, Billingham ME (1990) Pathologic changes in the long-term transplanted heart: a morphometric study of myocardial hypertrophy, vascularity, and fibrosis. Hum Pathol 21(7):767

    Article  CAS  Google Scholar 

  28. Sado DM, Flett AS, Banypersad SM, White SK, Maestrini V, Quarta G, Lachmann RH, Murphy E, Mehta A, Hughes DA (2012) Cardiovascular magnetic resonance measurement of myocardial extracellular volume in health and disease. Heart 98(19):1436–1441

    Article  Google Scholar 

  29. Baeßler B, Schaarschmidt F, Stehning C, Schnackenburg B, Maintz D, Bunck AC (2015) A systematic evaluation of three different cardiac T2-mapping sequences at 1.5 and 3T in healthy volunteers. Eur J Radiol 84(11):2161–2170

    Article  Google Scholar 

  30. Steen H, Merten C, Refle S, Klingenberg R, Dengler T, Giannitsis E, Katus HA (2008) Prevalence of different gadolinium enhancement patterns in patients after heart transplantation. J Am Coll Cardiol 52(14):1160–1167

    Article  Google Scholar 

  31. Maceira AM, Joshi J, Prasad SK, Moon JC, Perugini E, Harding I, Sheppard MN, Poolewilson PA, Hawkins PN, Pennell DJ (2005) Cardiovascular magnetic resonance in cardiac amyloidosis. Circulation 111(2):186

    Article  Google Scholar 

  32. Moon JC, Sheppard M, Reed E, Lee P, Elliott PM, Pennell DJ (2006) The histological basis of late gadolinium enhancement cardiovascular magnetic resonance in a patient with Anderson-Fabry disease. J Cardiovasc Magn Reson 8(3):479–482

    Article  Google Scholar 

  33. Moon JC, Mundy HR, Lee PJ, Mohiaddin RH, Pennell DJ (2003) Images in cardiovascular medicine. Myocardial fibrosis in glycogen storage disease type III. Circulation 107(7):e47

    Article  Google Scholar 

  34. Atkison P, Joubert G, Barron A, Grant D (1995) Hypertrophic cardiomyopathy associated with tacrolimus in paediatric transplant patients. Lancet 345(8954):894–896

    Article  CAS  Google Scholar 

  35. Mano A, Nakatani T, Yahata Y, Kato T, Hashimoto S, Wada K, Ishibashi-Ueda H (2009) Reversible myocardial hypertrophy induced by tacrolimus in a pediatric heart transplant recipient: case report. Transplant Proc 41(9):3831–3834

    Article  CAS  Google Scholar 

  36. Coelho-Filho OR, Shah R, Neilan TG, Mattos Souza JR, Barros Júnior JC, Lavagnoli CFR, Silveira-Filho LdM, de Oliveira PPM, Severino ES, Jerosch-Herold M, Petrucci O (2015) Characterization of both myocardial extracellular volume expansion and myocyte hypertrophy by CMR in heart transplantation recipients without active rejection: implications for early cardiac remodeling. J Cardiovasc Magn Reson 17(1):1–2

    Article  Google Scholar 

Download references

Funding

This study was partly supported by the National Natural Science Foundation of China (Grant Nos. 81701653 and WJ2017Q019).

Author information

Author notes

  1. Yating Yuan and Jie Cai have contributed equally to this work.

Authors and Affiliations

  1. Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Avenue, Wuhan, 430022, China

    Yating Yuan, Yue Cui, Jing Wang, Osamah Alwalid, Xuehua Shen, Yukun Cao, Yan Zou & Bo Liang

  2. Department of Cardiac Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Avenue, Wuhan, 430022, China

    Jie Cai

Authors
  1. Yating Yuan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jie Cai
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yue Cui
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jing Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Osamah Alwalid
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Xuehua Shen
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Yukun Cao
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Yan Zou
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Bo Liang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Bo Liang.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study was approved by the local research ethics board (Tongji Medical College Ethics Board, Huazhong University of Science and Technology) and in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Informed consent

Written informed consent was obtained from each patient.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yuan, Y., Cai, J., Cui, Y. et al. CMR-derived extracellular volume fraction (ECV) in asymptomatic heart transplant recipients: correlations with clinical features and myocardial edema. Int J Cardiovasc Imaging 34, 1959–1967 (2018). https://doi.org/10.1007/s10554-018-1421-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10554-018-1421-2

Keywords

Search

Navigation