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Eur J Cardiothorac Surg 2006;29:45-49
© 2006 Elsevier Science NL

Non-invasive diagnostic of cardiac allograft vasculopathy by ³¹P magnetic resonance chemical shift imaging

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

Received 16 September 2005; accepted 13 October 2005.

^_* Corresponding author. Tel.: +33 49 1324471; fax: +33 49 1256539. (Email: thierry.caus{at}hotmail.com).

Background: Coronary angiography is still the gold standard for the diagnosis of cardiac allograft vasculopathy (CAV) for which alternative non-invasive diagnostic approaches are currently investigated. In this study, we assessed whether ³¹P magnetic resonance chemical shift imaging can diagnose CAV by studying variations in cardiac high-energy phosphates in a population of adult heart transplant recipients. Methods and results: CAV was defined by coronary angiography as the presence of diffuse coronary irregularities with significant concentric narrowing on epicardial or distal coronary arteries. Eight patients with CAV (group A), and 18 patients without CAV (group B) were included in this study and compared to nine healthy volunteers (group C). Patients and volunteers underwent ³¹P three-dimensional chemical shift imaging to determine the ratio of phosphocreatine (PCr) and adenosine tri-phosphate (ATP). PCr/ATP was significantly lower in group A (1.51 ± 0.50) than in groups B and C (1.98 ± 0.53 (p = 0.003) and 2.14 ± 0.31 (p = 0.001)), respectively. Time from transplant, number of episodes of acute rejection, and left ventricular ejection fraction (LVEF) were not significantly different between patient groups. A PCr/ATP value of 1.59 was the optimal cut-off value to predict CAV (specificity and sensitivity of 100% and 72%, respectively). Conclusion: Clinically, in vivo ³¹P chemical shift imaging is a promising, non-invasive method to detect the potential modifications of high-energy phosphates related to CAV and to better screen indications for coronary angiograms. This may be relevant for coronary angiography follow-up and adjustments of immunotherapy regimen.

Key Words: MRS • Coronary circulation • Transplantation

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