Prevalence of Different Gadolinium Enhancement Patterns in Patients After Heart Transplantation

Prevalence of Different Gadolinium Enhancement Patterns in Patients After Heart Transplantation Henning Steen, Constanze Merten, Sonja Refle, Roland Klingenberg, Thomas Dengler, Evangelos Giannitsis, Hugo A. Katus Coronary angiography, which is routinely used for estimation of heart transplant (HTX) coronary artery disease (TCAD; I = mild; II = 30% to 75%, III = ≥75% stenosis), underestimates the intramural atherosclerotic process and could overlook subclinical myocardial infarctions (MIs). Contrast-enhanced magnetic resonance imaging (CE-MRI) noninvasively identifies infarct-typical subendocardial MI and focal nonischemic fibrosis. Infarct-typical CE-MRI was already present in TCAD I + II and increased significantly between groups (p < 0.05). Infarct-atypical CE-MRI was equally distributed across all TCAD stages (p = NS). Patients with only infarct-atypical CE-MRI had significantly better left ventricular function than with infarct-typical or combined patterns (p ≤ 0.05). CE-MRI allowed for identification of silent MI in apparently event-free HTX patients and disclosed focal nonischemic fibrosis already in early TCAD stages.