Cardiovascular Magnetic Resonance for Rejection Surveillance After Cardiac Transplantation.

Anthony, C; Imran, M; Pouliopoulos, J; Emmanuel, S; Iliff, J; Liu, Z; Moffat, K; Ru Qiu, M; McLean, CA; Stehning, C; Puntmann, V; Vassiliou, V; Ismail, TF; Gulati, A; Prasad, S; Graham, RM; McCrohon, J; Holloway, C; Kotlyar, E; Muthiah, K; Keogh, AM; Hayward, CS; Macdonald, PS; Jabbour, A

Cardiovascular Magnetic Resonance for Rejection Surveillance After Cardiac Transplantation.

Anthony, C Imran, M Pouliopoulos, J Emmanuel, S Iliff, J Liu, Z Moffat, K Ru Qiu, M McLean, CA Stehning, C Puntmann, V Vassiliou, V Ismail, TF Gulati, A Prasad, S Graham, RM McCrohon, J Holloway, C Kotlyar, E Muthiah, K Keogh, AM Hayward, CS Macdonald, PS Jabbour, A

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Publisher:: Ovid Technologies (Wolters Kluwer Health)
Publication Type:: Journal Article
Citation:: Circulation, 2022, 145, (25), pp. 1811-1824
Issue Date:: 2022-06-21

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Field	Value	Language
dc.contributor.author	Anthony, C
dc.contributor.author	Imran, M
dc.contributor.author	Pouliopoulos, J
dc.contributor.author	Emmanuel, S
dc.contributor.author	Iliff, J
dc.contributor.author	Liu, Z
dc.contributor.author	Moffat, K
dc.contributor.author	Ru Qiu, M
dc.contributor.author	McLean, CA
dc.contributor.author	Stehning, C
dc.contributor.author	Puntmann, V
dc.contributor.author	Vassiliou, V
dc.contributor.author	Ismail, TF
dc.contributor.author	Gulati, A
dc.contributor.author	Prasad, S
dc.contributor.author	Graham, RM
dc.contributor.author	McCrohon, J
dc.contributor.author	Holloway, C
dc.contributor.author	Kotlyar, E
dc.contributor.author	Muthiah, K
dc.contributor.author	Keogh, AM
dc.contributor.author	Hayward, CS
dc.contributor.author	Macdonald, PS
dc.contributor.author	Jabbour, A
dc.date.accessioned	2022-12-02T02:10:27Z
dc.date.available	2022-12-02T02:10:27Z
dc.date.issued	2022-06-21
dc.identifier.citation	Circulation, 2022, 145, (25), pp. 1811-1824
dc.identifier.issn	0009-7322
dc.identifier.issn	1524-4539
dc.identifier.uri	http://hdl.handle.net/10453/164051
dc.description.abstract	BACKGROUND: Endomyocardial biopsy (EMB) is the gold standard method for surveillance of acute cardiac allograft rejection (ACAR) despite its invasive nature. Cardiovascular magnetic resonance (CMR)-based myocardial tissue characterization allows detection of myocarditis. The feasibility of CMR-based surveillance for ACAR-induced myocarditis in the first year after heart transplantation is currently undescribed. METHODS: CMR-based multiparametric mapping was initially assessed in a prospective cross-sectional fashion to establish agreement between CMR- and EMB-based ACAR and to determine CMR cutoff values between rejection grades. A prospective randomized noninferiority pilot study was then undertaken in adult orthotopic heart transplant recipients who were randomized at 4 weeks after orthotopic heart transplantation to either CMR- or EMB-based rejection surveillance. Clinical end points were assessed at 52 weeks. RESULTS: Four hundred one CMR studies and 354 EMB procedures were performed in 106 participants. Forty heart transplant recipients were randomized. CMR-based multiparametric assessment was highly reproducible and reliable at detecting ACAR (area under the curve, 0.92; sensitivity, 93%; specificity, 92%; negative predictive value, 99%) with greater specificity and negative predictive value than either T1 or T2 parametric CMR mapping alone. High-grade rejection occurred in similar numbers of patients in each randomized group (CMR, n=7; EMB, n=8; P=0.74). Despite similarities in immunosuppression requirements, kidney function, and mortality between groups, the rates of hospitalization (9 of 20 [45%] versus 18 of 20 [90%]; odds ratio, 0.091; P=0.006) and infection (7 of 20 [35%] versus 14 of 20 [70%]; odds ratio, 0.192; P=0,019) were lower in the CMR group. On 15 occasions (6%), patients who were randomized to the CMR arm underwent EMB for clarification or logistic reasons, representing a 94% reduction in the requirement for EMB-based surveillance. CONCLUSIONS: A noninvasive CMR-based surveillance strategy for ACAR in the first year after orthotopic heart transplantation is feasible compared with EMB-based surveillance. REGISTRATION: HREC/13/SVH/66 and HREC/17/SVH/80. AUSTRALIAN NEW ZEALAND CLINICAL TRIALS REGISTRY: ACTRN12618000672257.
dc.format	Print-Electronic
dc.language	eng
dc.publisher	Ovid Technologies (Wolters Kluwer Health)
dc.relation.ispartof	Circulation
dc.relation.isbasedon	10.1161/CIRCULATIONAHA.121.057006
dc.rights	info:eu-repo/semantics/closedAccess
dc.subject	1102 Cardiorespiratory Medicine and Haematology, 1103 Clinical Sciences, 1117 Public Health and Health Services
dc.subject.classification	Cardiovascular System & Hematology
dc.subject.mesh	Adult
dc.subject.mesh	Australia
dc.subject.mesh	Biopsy
dc.subject.mesh	Cross-Sectional Studies
dc.subject.mesh	Graft Rejection
dc.subject.mesh	Heart Transplantation
dc.subject.mesh	Humans
dc.subject.mesh	Magnetic Resonance Spectroscopy
dc.subject.mesh	Myocarditis
dc.subject.mesh	Myocardium
dc.subject.mesh	Pilot Projects
dc.subject.mesh	Prospective Studies
dc.subject.mesh	Myocardium
dc.subject.mesh	Humans
dc.subject.mesh	Myocarditis
dc.subject.mesh	Biopsy
dc.subject.mesh	Heart Transplantation
dc.subject.mesh	Magnetic Resonance Spectroscopy
dc.subject.mesh	Prospective Studies
dc.subject.mesh	Cross-Sectional Studies
dc.subject.mesh	Pilot Projects
dc.subject.mesh	Graft Rejection
dc.subject.mesh	Adult
dc.subject.mesh	Australia
dc.title	Cardiovascular Magnetic Resonance for Rejection Surveillance After Cardiac Transplantation.
dc.type	Journal Article
utslib.citation.volume	145
utslib.location.activity	United States
utslib.for	1102 Cardiorespiratory Medicine and Haematology
utslib.for	1103 Clinical Sciences
utslib.for	1117 Public Health and Health Services
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
utslib.copyright.status	closed_access	*
dc.date.updated	2022-12-02T02:10:25Z
pubs.issue	25
pubs.publication-status	Published
pubs.volume	145
utslib.citation.issue	25

Abstract:

BACKGROUND: Endomyocardial biopsy (EMB) is the gold standard method for surveillance of acute cardiac allograft rejection (ACAR) despite its invasive nature. Cardiovascular magnetic resonance (CMR)-based myocardial tissue characterization allows detection of myocarditis. The feasibility of CMR-based surveillance for ACAR-induced myocarditis in the first year after heart transplantation is currently undescribed. METHODS: CMR-based multiparametric mapping was initially assessed in a prospective cross-sectional fashion to establish agreement between CMR- and EMB-based ACAR and to determine CMR cutoff values between rejection grades. A prospective randomized noninferiority pilot study was then undertaken in adult orthotopic heart transplant recipients who were randomized at 4 weeks after orthotopic heart transplantation to either CMR- or EMB-based rejection surveillance. Clinical end points were assessed at 52 weeks. RESULTS: Four hundred one CMR studies and 354 EMB procedures were performed in 106 participants. Forty heart transplant recipients were randomized. CMR-based multiparametric assessment was highly reproducible and reliable at detecting ACAR (area under the curve, 0.92; sensitivity, 93%; specificity, 92%; negative predictive value, 99%) with greater specificity and negative predictive value than either T1 or T2 parametric CMR mapping alone. High-grade rejection occurred in similar numbers of patients in each randomized group (CMR, n=7; EMB, n=8; P=0.74). Despite similarities in immunosuppression requirements, kidney function, and mortality between groups, the rates of hospitalization (9 of 20 [45%] versus 18 of 20 [90%]; odds ratio, 0.091; P=0.006) and infection (7 of 20 [35%] versus 14 of 20 [70%]; odds ratio, 0.192; P=0,019) were lower in the CMR group. On 15 occasions (6%), patients who were randomized to the CMR arm underwent EMB for clarification or logistic reasons, representing a 94% reduction in the requirement for EMB-based surveillance. CONCLUSIONS: A noninvasive CMR-based surveillance strategy for ACAR in the first year after orthotopic heart transplantation is feasible compared with EMB-based surveillance. REGISTRATION: HREC/13/SVH/66 and HREC/17/SVH/80. AUSTRALIAN NEW ZEALAND CLINICAL TRIALS REGISTRY: ACTRN12618000672257.

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