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Eur J Cardiothorac Surg 2005;28:576-580
© 2005 Elsevier Science NL

Original articles

³¹P MRS of heart grafts provides metabolic markers of early dysfunction

^a Centre de Résonance Magnétique Biologique et Médicale (CRMBM), UMR CNRS 6612, Fac. Med., 27 Bd Jean Moulin, 13005 Marseille, France
^b Service de Chirurgie Cardiaque, CHU Timone, 13005 Marseille, France

Received 1 June 2005; received in revised form 8 July 2005; accepted 13 July 2005.

^* Corresponding author. Address: Service de Chirurgie Cardiaque, CHU Timone, 13005 Marseille, France. Tel.: +33 491 324471; fax: +33 491 256539. (Email: tcaus{at}ap-hm.fr).

Abstract

Objective: Early graft failure (EGF) is a life-threatening event still accounting for a significant percentage of early deaths after heart transplantation. We tested whether selected metabolic markers, including high-energy phosphate concentrations measured ex vivo in pre-transplant heart grafts by ³¹P magnetic resonance spectroscopy (MRS) are related with early post-transplant outcome. Methods: During a 3-year period, 26 heart grafts harvested in the vicinity of the transplantation centre were studied. Evaluation of transplantability was done conventionally. ³¹P MRS was performed ex vivo approximately 60min after aortic cross-clamp to quantify ATP, P_i and PCr concentration ratios. A MRS-score was defined as a combination of intracellular pH (pHi) and the PCr/P_i ratio. EGF was defined as the need to abnormally extend circulatory support or to use more than two inotropes before weaning the patient from CPB after transplantation. The grafts were attributed to three groups as follows: A1, transplanted with uneventful outcome (n=14); A2, transplanted with subsequent EGF (n=3) and B, not suitable for transplantation (n=9). Results: Significant differences between groups existed for the following metabolic markers: PCr/ATP (P=0.013), PCr/P_i (P=0.0004), pHi (P=0.0016) and MRS-score (P=0.0001). The sensitivity, specificity and positive likelihood ratio for EGF with a MRS-score1.95 were, respectively, 100%, 86% and 7. Conclusions: In the setting of this study, post-transplant outcome was related to the pre-transplant MRS-score of grafts evaluated ex vivo. This result might help to more securely use grafts from marginal donors.

Key Words: Heart transplantation • Graft failure • Phosphorus magnetic resonance spectroscopy