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Rapid Fire Abstracts

Rapid Fire 04- Heart Failure I

Long Term Relationship of Structural-Functional CMR Parameters in Post-Heart Transplant CAV Surveillance (RF_TH_265)

Thursday, January 30, 2025
5:30 PM – 5:40 PM East Coast USA Time
Location: Blue Room PreFunction
Background: Long term surveillance for cardiac allograft vasculopathy (CAV) is required in patients post-heart transplant (HTx) and cardiac magnetic resonance imaging (CMR) is increasingly utilized for this purpose. Myocardial strain analysis is utilized in several conditions, including post-HTx1-3, for eliciting subtle myocardial dysfunction, with global longitudinal strain (GLS) being the most clinically utilized. The aim of our study was to evaluate baseline and longitudinal changes in structural and strain parameters using CMR in patients undergoing long term follow up (f.u.) for CAV.

Methods: Sixty-three patients who received at least 2 CMR scans ( >1yr & < 11yrs post-HTx) were included, with median time between scans of 3.3 years (IQR 1.3–5.5yrs). The baseline scan was considered the first CMR scan for CAV surveillance ( >1yr post-HTx), and the most recent CMR was considered the f.u. scan. Commercial software (CVI42, Circle, V5.14.2) was utilized for right and left ventricular (RV, LV) volumes and function, T1 native and post-contrast (PC-T1), T2 and two-dimensional feature-tracking strain calculations. Baseline to follow up changes were indexed to time (in years, both absolute (Δ/yr) and percent (%Δ/yr)). For grouped analysis, indications for HTx were organized into three groups: ischemic heart disease (IHD), idiopathic cardiomyopathy (ICM), and Other. Cohort characteristics are in Fig 1.

Results: In whole cohort analysis, both PC-T1 and T2 significantly decreased from first to f.u. scan (PC-T1: -38.8ms, Δ/yr = -6.3ms; %Δ/yr= -0.3,  p< 0.01;  T2: -1.1ms, Δ/yr = -0.5ms, %Δ/yr= -0.7, p< 0.05) while LV ejection fraction (EF) significantly increased on average (LVEF: 3.1%; Δ/yr = 1.1%; %Δ/yr= 2.9, p< 0.05). GLS was -13.2% and -12.5% at f.u. (p >0.05). (Fig 2). Changes in PC-T1 negatively correlated with changes in LV global radial (r=-0.43, p< 0.05) and circumferential (r=-0.55, p< 0.01) strain (GRS, GCS). Grouped analysis revealed normal  LVEF in all groups at baseline and f.u., while GLS worsened over time both in the IHD (p=0.05) and in the Other group (p< 0.05). (Fig 3). The ICM HTx group also showed: 1) significant decrease in PC-T1 (-35ms, Δ/yr = -18.8ms; % Δ/yr=-3.7,  p< 0.01) with a positive correlation between PC-T1 and LVEDV (r=0.73, p< 0.01), RV-EDV (r=0.52, p< 0.05) and LVESV(r=0.44, p< 0.05) and 2) significant positive correlation between T2 and RVESV (r=0.49, p< 0.05).

Conclusion:

In HTx patients monitored for CAV, CMR shows significant structural myocardial parameters’ variation at long term f.u. PC-T1 increase is related to ventricular volume increase and LV strain decrease. Differently from LVEF, GLS doesn’t increase over time in the whole cohort, and trends down in 2 of the 3 groups, likely reflecting a subtle persistent myocardial dysfunction, already evident at initial stages of  CAV. In ICM and IHD groups, correlations between T2 and RV volume change may suggest an RV involvement from processes increasing LV T2 (e.g. inflammation).