The role of CMR in the evaluation of acute mixed cardiac allograft rejection
Suhai Ferenc Imre1, Sax Balázs1, Assabiny Alexandra1, Király Ákos1, Czimbalmos Csilla1, Csécs Ibolya1, Kovács Attila1, Lakatos Bálint1, Németh Endre2, Becker Dávid1, Szabolcs Zoltán1, Hubay Márta3, Merkely Béla1, Vágó Hajnalka1
1Városmajori Szív- és Érgyógyászati Klinika,
2Aneszteziológiai és Intenzív Terápiás Klinika,
3Igazságügyi és Biztosítás-orvostani Intézet, Budapest
Despite of the modern immunosuppressive therapy the acute cardiac allograft rejection is a leading cause of morbidity and mortality in heart transplant patients. Endomyocardial biopsy is considered the current gold standard for the diagnosis of acute cardiac rejection, nevertheless there is an intense research regarding on non-invasive diagnostic methods in this field. Cardiac magnetic resonance imaging (CMR) has an evolving role in the detection of acute rejection among these modalities because of its ability to quantify ventricular function and characterize the complete myocardial tissue. There are only few data of the mixed (cellular and humoral) rejection which is a very rare entity, and the diagnosis remains challenging. Our knowledge about the CMR findings of mixed cardiac rejection is limited as well. In the last year we have made a diagnosis of mixed cardiac rejection in three patients, and the subsequently performed CMR showed very similar features in each patients. We performed serial CMR examinations in one patient to follow-up the changes of left and right ventricular volumes, ejection fractions and the pattern of myocardial oedema and delayed contrast enhancement.
Project no. NVKP_16-1-2016-0017 has been implemented with the support provided from the National Research, Development and Innovation Fund of Hungary, financed under the NVKP_16 funding scheme.”