Diffuse myocardial fibrosis among healthy pediatric heart transplant recipients: Correlation of histology, cardiovascular magnetic resonance, and clinical phenotype

作者：Feingold Brian^*; Salgado Claudia M; Reyes Mugica Miguel; Drant Stacey E; Miller Susan A; Kennedy Mark; Kellman Peter; Schelbert Erik B; Wong Timothy C

来源：Pediatric Transplantation, 2017, 21(5): e12986.

DOI：10.1111/petr.12986

• allograft survival
• cardiac magnetic resonance imaging
• chronic rejection
• extracellular volume
• fibrosis
• heart transplantation
• interstitium
• pediatric

Fibrosis is commonly described in heart allografts lost late after transplantation. CMR-derived ECV is a validated measure of DMF in native adult hearts that may predict heart failure and mortality. We explored associations of ECV with histologic myocardial fibrosis and clinical features after pediatric heart transplantation. Twenty-five recipients (7.0 +/- 6.3years at transplant and 10.7 +/- 6.5years post-transplant) were prospectively recruited for CMR and BNP measurement at the time of surveillance biopsy. All had normal ejection fractions and lacked heart failure symptoms. Fibrosis was quantified on biopsy after picrosirius red staining as CVF. ECV was quantified using contemporaneous hematocrit on basal and mid-short-axis slices. ECV was moderately correlated with CVF (r=.47; P=.019). We found no associations of ECV with hemodynamics, ischemic time, time since transplantation, or number of prior biopsies or acute rejections. Compared to healthy non-transplant controls, there was no significant difference in ECV (25.1 +/- 3.0 vs 23.7 +/- 2.0%, P=.09). Log-transformed BNP was correlated with ECV (recipients: r=.46, P=.02; recipients and controls: r=.45, P=.006). These findings suggest ECV quantifies DMF and relates to biological indicators of cardiac function after pediatric heart transplantation.

• 出版日期2017-8