Prognostic impact of late gadolinium enhancement in the risk stratification of heart transplant patients

The aim of the present study was to assess the association of the presence and amount of late gadolinium enhancement (LGE) at cardiac magnetic resonance (CMR) with cardiovascular adverse events in patients with orthotopic heart transplantation (HTx).

We enrolled 48 patients (mean age, 54.7 ± 14.6 years; 37 men) at various stages after HTx. All patients underwent standard CMR at 1.5 T, to characterize both cardiac anatomy and LGE. Late gadolinium enhancement was detected in 26 patients (54%). All-cause and cardiovascular mortalities, and a composite of major adverse cardiovascular events (MACE) recurrence were evaluated during the follow-up period for a median of 5.16 years. Ten patients (21%) died and 26 (54%) were readmitted because of MACE. Multivariate Cox analysis identified as independent predictors of MACE a diagnosis of cardiac allograft vasculopathy (CAV) (HR 3.63; 1.5–8.7 95% CI; P = 0.0039), left ventricular end systolic volume index (HR 1.04; 95% CI 1.01–1.079; P = 0.008), LGE mass (HR 1.04; 1.01–1.06 95% CI; P = 0.0007), LGE % of left ventricular mass (HR 1.083; 1.03–1.13 95% CI; P = 0.0002). Independent predictors of all-cause death were CAV (HR 6.33; 95% CI 1.33–30.03; P = 0.0201), LGE mass (HR 1.04; 1.01–1.07 95% CI; P = 0.005), LGE % of left ventricular mass (HR 1.075; 1.02–1.13 95% CI; P = 0.007). Patients with CAV had a risk of MACE by 5 years of 67% (95% CI 0.309–0.851%); the addition of 7.9 LGE % to the risk model increased the predicted risk to 88% (95% CI 0.572–0.967%).

The current study demonstrated that the presence of CAV and the total amount of LGE have a significant independent association with MACE and mortality in HTx patients.