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Diagnostic performance of late gadolinium enhancement in the assessment of acute cellular rejection after heart transplantation [Anatol J Cardiol]
Anatol J Cardiol. 2016; 16(2): 113-118 | DOI: 10.5152/AnatolJCardiol.2015.5961  

Diagnostic performance of late gadolinium enhancement in the assessment of acute cellular rejection after heart transplantation

Evrim Şimşek1, Sanem Nalbantgil1, Naim Ceylan2, Mehdi Zoghi1, Hatice Soner Kemal1, Çağatay Engin3, Tahir Yağdı3, Mustafa Özbaran3
1Departments Of Cardiology, Faculty Of Medicine, Ege University; İzmir- Turkey
2Radiology, Faculty Of Medicine, Ege University; İzmir- Turkey
3Cardiovascular Surgery, Faculty Of Medicine, Ege University; İzmir- Turkey

Objective: Allograft rejection is still an important cause of morbidity and mortality after heart transplantation (HTx). Many techniques in cardiac magnetic resonance imaging (CMR) were investigated to diagnose acute cellular rejection (ACR). However, there is not enough information about late gadolinium enhancement (LGE) in the myocardium and ACR.
Methods: We prospectively analyzed our consecutive 41 heart transplant recipients who were admitted for routine endomyocardial biopsies. CMR was performed maximum 6 h before the scheduled endomyocardial biopsy. Correlation between LGE in the myocardium and ACR was investigated.
Results: Twenty-seven patients showed no rejection, and nine of them had LGE in the myocardium. Fourteen patients had LGE in the left ventricle (LV), and two patients had LGE also in the right ventricle (RV). There was no correlation between LGE and ACR (p=0.879). There was no difference in the left ventricular ejection fraction (LVEF), right ventricular fractional area change (RVFAC), and cardiac ischemic time between the groups (p=0.825, p=0.370, and p=0.419, respectively). LGE in the myocardium could be due to previous rejection episodes; therefore, all patients were retrospectively searched for previous rejection grades and number of episodes. Thirty-eight of the 41 patients had a history of one ACR episode, but none of them had a statistically significant correlation with LGE (for grade 1R, p=0.964 and grade 3R, p=1) There was also no correlation between number of rejection episodes history and LGE.
Conclusion: LGE is not suitable to detect ACR in heart transplant patients. LGE and the history of ACR have no correlation.

Keywords: heart transplantation, graft rejection, cardiac magnetic resonance imaging


Evrim Şimşek, Sanem Nalbantgil, Naim Ceylan, Mehdi Zoghi, Hatice Soner Kemal, Çağatay Engin, Tahir Yağdı, Mustafa Özbaran. Diagnostic performance of late gadolinium enhancement in the assessment of acute cellular rejection after heart transplantation. Anatol J Cardiol. 2016; 16(2): 113-118

Corresponding Author: Evrim Şimşek, Türkiye


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