What does this research mean for the field?

A noninvasive cardiovascular magnetic resonance (CMR)-based surveillance strategy is a feasible and highly reliable alternative to endomyocardial biopsy for detecting acute cardiac allograft rejection, significantly reducing the need for invasive biopsies while lowering hospitalization and infection rates. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.ESTABLISHES_NEW_DIRECTION.

What question did this study set out to answer?

To evaluate whether noninvasive cardiovascular magnetic resonance multiparametric mapping can reliably detect acute cardiac allograft rejection and serve as an effective surveillance strategy compared to invasive endomyocardial biopsy.

June 21, 2022CirculationOpen Access

Cardiovascular Magnetic Resonance for Rejection Surveillance After Cardiac Transplantation

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Why the study?

Endomyocardial biopsy is invasive despite being the gold standard for acute cardiac allograft rejection surveillance, and the feasibility of CMR-based surveillance in the first year after heart transplantation is undescribed.

Does CMR-based rejection surveillance improve clinical outcomes compared to EMB-based surveillance in adult orthotopic heart transplant recipients?

Comparison

CMR-based rejection surveillance vs EMB-based rejection surveillance

Design

Prospective randomized noninferiority pilot study

Follow-up

52 weeks

Authors

CAChris AnthonyCleveland Clinic MIMuhammad ImranUniversity of Peshawar JPJim PouliopoulosElectrophysiology

Discussion

Member takes

Implication

CMR surveillance cut hospitalizations and infections without raising rejection; supports noninvasive monitoring as alternative to routine EMB in heart transplant recipients.

Key Points

To evaluate whether noninvasive cardiovascular magnetic resonance multiparametric mapping can reliably detect acute cardiac allograft rejection and serve as an effective surveillance strategy compared to invasive endomyocardial biopsy.
Multiparametric mapping was evaluated cross-sectionally across 401 cardiovascular magnetic resonance (CMR) scans and 354 endomyocardial biopsies (EMB) in 106 participants to determine rejection diagnostic cutoffs.
A prospective randomized noninferiority pilot trial assigned 40 adult orthotopic heart transplant recipients at 4 weeks post-transplant to either CMR-based or EMB-based rejection surveillance, assessing clinical endpoints at 52 weeks (ACTRN12618000672257).
CMR-based multiparametric mapping demonstrated high diagnostic accuracy for acute rejection with an area under the curve of 0.92, 93% sensitivity, 92% specificity, and 99% negative predictive value.
High-grade rejection occurred in 7 of 20 CMR patients compared with 8 of 20 EMB patients (P = 0.74).
CMR surveillance was associated with lower rates of hospitalization (9/20 [45%] vs 18/20 [90%]; odds ratio, 0.091; P = 0.006) and infection (7/20 [35%] vs 14/20 [70%]; odds ratio, 0.192; P = 0.019), reducing overall biopsy requirements by 94%.

Structured PICO

Does CMR-based rejection surveillance improve clinical outcomes compared to EMB-based surveillance in adult orthotopic heart transplant recipients?

Population

106 adult orthotopic heart transplant recipients (40 randomized at 4 weeks post-transplant)

Intervention

Cardiovascular magnetic resonance (CMR)-based rejection surveillance

Comparator

Endomyocardial biopsy (EMB)-based rejection surveillance

Outcome

Clinical end points including high-grade rejection, hospitalization, infection, kidney function, and mortality assessed at 52 weekshard clinical

A noninvasive CMR-based surveillance strategy for acute cardiac allograft rejection is feasible and may reduce hospitalizations and infections compared to routine endomyocardial biopsy.

Cite This Study

Anthony et al. (2022) studied this question.

synapsesocial.com/papers/6a1e344c40bc8a3dd768a07f https://doi.org/10.1161/circulationaha.121.057006

Topics

Heart transplantation Myocarditis

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Implication

CMR surveillance cut hospitalizations and infections without raising rejection; supports noninvasive monitoring as alternative to routine EMB in heart transplant recipients.