JHLT open · 2026
T1 mapping for diagnosis of early cardiac cellular allograft rejection.
СтатьяНазвание и аннотация: Перевод в очереди
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Soares L P M A, Marcondes-Braga F G, Dantas R N, Lima B B, Faria V S, Scussel A A, Dantas R C T, Mangini S, Campos I W, Seguro L F B C, Avila M S, Gaiotto F A, Nomura C H, Bacal F
Аннотация
BACKGROUND: Non-invasive surveillance of acute cellular rejection (ACR) has become a primary focus in heart transplantation (HTx), aiming to reduce the frequency of invasive endomyocardial biopsies (EMB). While cardiac magnetic resonance (CMR) with T1 mapping has shown promise as a diagnostic tool, its application during the early post-transplant phase remains a significant knowledge gap, as perioperative tissue injury can confound imaging interpretation.
OBJECTIVE: To evaluate the accuracy of cardiac T1 mapping for ACR in heart transplant recipients within the first 60 days post-transplantation, using EMB as the reference standard.
METHODS: This prospective single-center study included adult HTx recipients within 60 days post-transplant. All patients underwent CMR with native T1 mapping and extracellular volume (ECV) quantification. EMB served as the gold standard, classifying patients into non-significant (<2R) and significant (≥2R) rejection groups.
RESULTS: Forty-five recipients were included; 14 (31.1%) presented with cellular rejection ≥2R. Baseline characteristics such as recipient mean age (50.1 vs 49.6 years, p = 0.79) and the interval from HTx to CMR (32 vs 31.4 days, p = 0.86) were comparable between groups. Native T1 (1048 ± 46.2 vs 1006.6 ± 60.6 ms, p = 0.028) and ECV (36.8 ± 5.3% vs 33.2 ± 5.5%, p = 0.043) were significantly elevated in the ≥2R group. Native T1 demonstrated an AUC of 0.700 for diagnosing rejection ≥2R (cutoff: 1036.5 ms; sensitivity 64.3%, specificity 74.2%, PPV 52.9%, NPV 82.1%), whereas ECV yielded an AUC of 0.726 (cutoff: 37.9%; sensitivity 57.1%, specificity 90.3%, PPV 72.7%, NPV 82.4%). Multivariate analysis identified indexed RV end-diastolic volume and the presence of late gadolinium enhancement (LGE) as independent predictors of rejection. However, a multiparametric approach combining native T1 <1037 ms, ECV <38%, and absence of LGE yielded a NPV of 100% within this small subgroup.
CONCLUSION: The diagnostic accuracy of standalone T1 mapping for identifying ACR was modest in this early post-HTx period. However, native T1 and ECV were significantly higher in the rejection group, and their integration into a multiparametric approach, including LGE, demonstrated a high NPV in this cohort. These findings highlight CMR's potential for monitoring myocardial changes even in the early post-transplant stage.
OBJECTIVE: To evaluate the accuracy of cardiac T1 mapping for ACR in heart transplant recipients within the first 60 days post-transplantation, using EMB as the reference standard.
METHODS: This prospective single-center study included adult HTx recipients within 60 days post-transplant. All patients underwent CMR with native T1 mapping and extracellular volume (ECV) quantification. EMB served as the gold standard, classifying patients into non-significant (<2R) and significant (≥2R) rejection groups.
RESULTS: Forty-five recipients were included; 14 (31.1%) presented with cellular rejection ≥2R. Baseline characteristics such as recipient mean age (50.1 vs 49.6 years, p = 0.79) and the interval from HTx to CMR (32 vs 31.4 days, p = 0.86) were comparable between groups. Native T1 (1048 ± 46.2 vs 1006.6 ± 60.6 ms, p = 0.028) and ECV (36.8 ± 5.3% vs 33.2 ± 5.5%, p = 0.043) were significantly elevated in the ≥2R group. Native T1 demonstrated an AUC of 0.700 for diagnosing rejection ≥2R (cutoff: 1036.5 ms; sensitivity 64.3%, specificity 74.2%, PPV 52.9%, NPV 82.1%), whereas ECV yielded an AUC of 0.726 (cutoff: 37.9%; sensitivity 57.1%, specificity 90.3%, PPV 72.7%, NPV 82.4%). Multivariate analysis identified indexed RV end-diastolic volume and the presence of late gadolinium enhancement (LGE) as independent predictors of rejection. However, a multiparametric approach combining native T1 <1037 ms, ECV <38%, and absence of LGE yielded a NPV of 100% within this small subgroup.
CONCLUSION: The diagnostic accuracy of standalone T1 mapping for identifying ACR was modest in this early post-HTx period. However, native T1 and ECV were significantly higher in the rejection group, and their integration into a multiparametric approach, including LGE, demonstrated a high NPV in this cohort. These findings highlight CMR's potential for monitoring myocardial changes even in the early post-transplant stage.