Emerging imaging techniques after cardiac transplantation

McDiarmid, Adam K; Plein, Sven; Ross, Heather J.

doi:10.1016/j.healun.2016.06.017

Cited by 3 publications

(5 citation statements)

References 84 publications

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“…Cardiac position emission tomography, on the other hand, has been used extensively to study graft perfusion after cardiac transplantation. As mentioned before for CMR perfusion evaluation, normal graft perfusion differs from native heart perfusion, and is increased at rest by approximately 40%; resting MBF decreases however with time after transplant, and may eventually return near normal levels [29].…”

Section: Evaluation Of Epicardial Coronary Lesions and Microvascular mentioning

confidence: 74%

“…Intracoronary imaging with optical coherence tomography (OCT) adds additional spatial resolution that may provide further diagnostic benefit, although it is a currently a research rather than a clinical tool [29]. [30]; this method was previously shown and validated against Doppler flow wire measurements in coronary artery disease [31].…”

Section: Evaluation Of Epicardial Coronary Lesions and Microvascular mentioning

confidence: 99%

“…As a predominantly qualitative technique, perfusion SPECT does not detect CAV until flow-limiting disease of epicardial coronary arteries is present [29].…”

Section: Evaluation Of Epicardial Coronary Lesions and Microvascular mentioning

confidence: 99%

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Non-Invasive Assessment of Coronary Microcirculation in Heart Transplantation

Michieli¹,

Lin²,

Tona³

2019

WJCD

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Heart transplantation (HT) is an accepted treatment for end-stage heart failure (HF). Heart transplantation significantly increases survival, exercise capacity, quality of life and return to work in selected patients with advanced heart failure compared with conventional treatment. The survival rates have improved with the use of new immunosuppressive drugs, with a median survival after transplantation of approximately 11 years. The shortage of donor hearts represents a major limitation in this field. In addition many are the consequences of the limited effectiveness and complications of immunosuppressive therapy (i.e. antibody-mediated rejection, infection, hypertension, renal failure, malignancy and coronary artery vasculopathy). In particular, chronic rejection may occur months to years after the transplantation and is referred to as cardiac allograft vasculopathy (CAV). CAV occurs in 32% of the patients after 5 years and ensuing allograft failure from CAV eventually accounts for 30% of recipient deaths after transplantation. Cardiac allograft vasculopathy, involving coronary macro-and microcirculation, is caused by complicated interplay between immunologic and non-immunologic factors resulting in repetitive endothelial injury and localized sustained inflammatory response. Early diagnosis of microvascular dysfunction is substantial. In this review we analyze signs and symptoms of CAV presentation and the different methodologies to achieve an early and precise diagnosis. We will discuss invasive and non-invasive diagnostic tools and their specific role in evaluating graft's function, morphology, the presence of coronary artery disease and possible microcirculation involvement.

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Section: Evaluation Of Epicardial Coronary Lesions and Microvascular mentioning

confidence: 74%

Section: Evaluation Of Epicardial Coronary Lesions and Microvascular mentioning

confidence: 99%

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Non-Invasive Assessment of Coronary Microcirculation in Heart Transplantation

Michieli¹,

Lin²,

Tona³

2019

WJCD

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“…The diagnosis of CAV is dependent on cardiac catheterization, which is an invasive procedure that requires anesthesia in young patients. More recently, non‐invasive modalities such as cardiac MRI, CT, and PET have been used to detect early CAV and rejection in the adult heart transplant population . However, little is known about the utility of these non‐invasive imaging modalities in the pediatric field.…”

Section: Introductionmentioning

confidence: 99%

“…More recently, non-invasive modalities such as cardiac MRI, CT, and PET have been used to detect early CAV and rejection in the adult heart transplant population. [3][4][5][6][7][8][9] However, little is known about the utility of these non-invasive imaging modalities in the pediatric field. Anesthesia is required for young patients, interpretation requires complex post-processing techniques, and there is associated radiation exposure for CT and PET.…”

Section: Introductionmentioning

confidence: 99%

Right atrial function in pediatric heart transplant patients by echocardiographic strain measurements

Watanabe

Schäfer

Cassidy

et al. 2019

Pediatric Transplantation

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Background CAV is a major cause of mortality in PHTx patients. Research on echocardiographic indices to detect CAV focuses primarily on ventricular function and less is known about RAF. Thus, we primarily sought to evaluate RAF in PHTx patients with CAV. For secondary analysis, we compared RAF between PHTx patients and control patients and evaluated RAF with respect to rejection and surgical type. Methods We retrospectively evaluated echocardiography derived RA strain indices in recipients <18 years old and >1 year from time of transplant. The RA strain phases included, reservoir (εs), conduit (εe), pump (εa), and respective strain rate indices (SRs, SRe, SRa). Results There were 36 PHTx patients and 14 age‐, sex‐matched control patients. There was a significant reduction in εs, εe, SRs, and SRe (P < 0.001) in the PHTx patients when compared to controls. There was no difference between the CAV (+) and CAV (−) patients with respect to RAF indices. Furthermore, εs, εe, and SRe (P < 0.05) were lower in patients with acute rejection (n = 7) compared to those without (n = 26). Patients with a bi‐atrial anastomosis (n = 14) had decreased εs, εa, SRs, SRa (P < 0.05), compared to bi‐caval anastomosis (n = 24). Conclusion PHTx patients have decreased RAF compared to healthy children. RAF does not differentiate PHTx patients based on the presence of CAV. RAF is also decreased in PHTx patients with rejection and in those transplanted with a bi‐atrial anastomosis.

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