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Serial cardiac magnetic resonance after heart transplantation: evolution of myocardial tissue characteristics, ventricular remodeling, and association with rejection
Session:
Sessão de Posters 50 - Terapêuticas avançadas na insuficiência cardíaca e em populações especiais
Speaker:
Ricardo Carvalheiro
Congress:
CPC 2026
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.3 Chronic Heart Failure – Diagnostic Methods
Session Type:
Posters Eletrónicos
FP Number:
---
Authors:
Ricardo Carvalheiro; Leonor Magalhães; Vera Vaz Ferreira; Ana Raquel Santos; Isabel Cardoso; António Valentim Gonçalves; Rita Ilhão Moreira; Tiago Pereira da Silva; Sílvia Aguiar Rosa; Rui Cruz Ferreira
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction</strong><br /> The role of serial cardiac magnetic resonance (CMR) after heart transplantation (HT) remains uncertain. This study aimed to characterize the evolution of ventricular remodelling, tissue mapping, and late gadolinium enhancement (LGE) on serial CMR, and to explore their association with biopsy-proven cellular rejection.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods</strong><br /> We prospectively evaluated 18 HT recipients between January 2024 and June 2025 who underwent an early CMR (CMR1; median 53 days post-HT) and a follow-up CMR (CMR2; median 192 days), both performed on the same 1.5T scanner. Endomyocardial biopsy (EMB) was performed near each CMR, and cellular rejection (≥2R) was identified in two patients at the time of CMR2.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results</strong><br /> In the overall cohort, ventricular size and function were within normal ranges at baseline. Native T1 was diffusely elevated (1096 ± 61 ms), with mild abnormalities also seen in T2 and extracellular volume (ECV) (Table 1). LGE was present in 7 patients (43.8%) and predominantly non-ischemic (5 patients, 31.3%). Hemodynamic–CMR coherence at baseline was demonstrated by a positive correlation between LV stroke volume index and cardiac index on right-heart catheterization (r = 0.63, p = 0.005) and an inverse correlation between pulmonary vascular resistance and RVEF (r = –0.47, p = 0.047).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Among patients without rejection, ventricular volumes and ejection fraction remained stable between CMR1 and CMR2. Mapping parameters showed a trend toward T1 reduction that did not reach statistical significance (ΔT1 −31 ms, p = 0.154), and only small, non-significant variations in T2 and ECV. LGE remained frequent but generally mild and predominantly non-ischemic. Ischemic injury was present in a minority at CMR1 (n = 2, 12.6%), with only one additional case identified at CMR2.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Patients with biopsy-proven rejection at CMR2 (n = 2) demonstrated significantly higher T2 values (66 ± 4 ms vs 51 ± 2 ms, p < 0.001) and more extensive LGE involvement (U = 0.5, p = 0.022), but the temporal changes in volumes and mapping provided additional discriminatory value. These patients exhibited marked increases in LV and RV end-diastolic indexed volumes (ΔLVEDVi +16.5 ml/m², p = 0.075; ΔRVEDVi +19 ml/m², p = 0.045), in contrast with the stability observed in non-rejection patients. Mapping trajectories also diverged: patients with rejection showed increases in T1 and T2 (ΔT1 +13 ms, p = 0.425; ΔT2 +5.5 ms, p = 0.046), whereas non-rejection patients demonstrated reductions.</span></span></p> <p><strong><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">Conclusions</span></span></strong><br /> <span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">In this preliminary cohort, serial CMR suggested that cellular rejection was associated with increasing ventricular dilation, mapping values, and LGE. In contrast, the remaining patients showed stable ventricular remodelling and partial normalization of mapping abnormalities. These findings highlight the potential value of serial CMR as a complementary tool for early detection of graft injury and monitoring post-transplant recovery.</span></span></p>
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