Scientific article
Open access

Quantification of myocardial interstitial fibrosis and extracellular volume for the detection of cardiac allograft vasculopathy

Published inThe international journal of cardiovascular imaging, vol. 36, no. 3, p. 533-542
Publication date2020-03
First online date2019-11-13

In search of a non-invasive alternative detection of early-stage cardiac allograft vasculopathy (CAV), in this preliminary study we tested the hypothesis that interstitial fibrosis quantified with cardiac magnetic resonance (CMR) can serve as a biomarker for the detection of CAV. Late-stage CAV was detected with routine X-ray coronary angiography (XRCA), while a coronary intima-media thickness ratio (IMTR) > 1 on optical coherence tomography (OCT) was used to detect early-stage CAV. Interstitial fibrosis was quantified in the endomyocardial biopsy (EMB) and indirectly with CMR as the T1 relaxation time and extracellular volume (ECV). CMR was performed within 48 h of a single invasive procedure with XRCA, OCT, and EMB procurement in stable HTx recipients (n = 27; age 54 ± 13 years, 5.4 ± 3.7 years post-transplant). XRCA-CAV and IMTR > 1 were present in 15% and 75% of study patients, respectively. The T1 relaxation times and ECV were increased in patients with XRCA-CAV (p = 0.03 each), while IMTR and EMB interstitial fibrosis were not significantly different (both p > 0.05). ECV (ρ = 0.46, p = 0.02) and IMTR (ρ = 0.58; p = 0.01) correlated with the histological quantity of interstitial fibrosis, while the T1 relaxation time (p = 0.06) did not. The correlation of the IMTR with the EMB interstitial fibrosis tentatively validates the hypothesis that interstitial fibrosis may serve as an early indicator of CAV. Moreover, the significant association of CMR-based ECV with the magnitude of interstitial fibrosis in the biopsy suggests ECV as a potential biomarker for interstitial fibrosis due to early-stage CAV. The measurement of ECV may therefore have a role for non-invasive detection and follow-up of early-stage CAV.

  • Cardiac allograft vasculopathy
  • Cardiovascular magnetic resonance
  • Extracellular volume
  • Heart transplantation
  • Interstitial fibrosis
  • Optical coherence tomography
  • Adult
  • Aged
  • Biopsy
  • Coronary Angiography
  • Coronary Artery Disease / diagnostic imaging
  • Coronary Artery Disease / etiology
  • Coronary Artery Disease / pathology
  • Early Diagnosis
  • Female
  • Fibrosis
  • Heart Transplantation / adverse effects
  • Humans
  • Magnetic Resonance Imaging, Cine
  • Male
  • Middle Aged
  • Myocardium / pathology
  • Pilot Projects
  • Predictive Value of Tests
  • Proof of Concept Study
  • Tomography, Optical Coherence
  • Treatment Outcome
  • Ventricular Remodeling
Affiliation Not a UNIGE publication
Citation (ISO format)
VAN HEESWIJK, Ruud B et al. Quantification of myocardial interstitial fibrosis and extracellular volume for the detection of cardiac allograft vasculopathy. In: The international journal of cardiovascular imaging, 2020, vol. 36, n° 3, p. 533–542. doi: 10.1007/s10554-019-01733-3
Main files (2)
Article (Accepted version)
Article (Published version)
ISSN of the journal1569-5794

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