Ferumoxytol-enhanced MRI in patients with prior cardiac transplantation

Stirrat, C. G. et al. (2019) Ferumoxytol-enhanced MRI in patients with prior cardiac transplantation. Open Heart, 6(2), e001115. (doi: 10.1136/openhrt-2019-001115) (PMID:31673393) (PMCID:PMC6802993)

Abstract

Objectives: Ultra-small superparamagnetic particles of iron oxide (USPIO)-enhanced MRI can detect cellular inflammation within tissues and may help non-invasively identify cardiac transplant rejection. Here, we aimed to determine the normal reference values for USPIO-enhanced MRI in patients with a prior cardiac transplant and examine whether USPIO-enhanced MRI could detect myocardial inflammation in patients with transplant rejection. Methods: Ten volunteers and 11 patients with cardiac transplant underwent T2, T2* and late gadolinium enhancement 1.5T MRI, with further T2* imaging at 24 hours after USPIO (ferumoxytol, 4 mg/kg) infusion, at baseline and 3 months. Results: Ten patients with clinically stable cardiac transplantation were retained for analysis. Myocardial T2 values were higher in patients with cardiac transplant versus healthy volunteers (53.8±5.2 vs 48.6±1.9 ms, respectively; p=0.003). There were no differences in the magnitude of USPIO-induced change in R2* in patients with transplantation (change in R2*, 26.6±7.3 vs 22.0±10.4 s-1 in healthy volunteers; p=0.28). After 3 months, patients with transplantation (n=5) had unaltered T2 values (52.7±2.8 vs 52.12±3.4 ms; p=0.80) and changes in R2* following USPIO (29.42±8.14 vs 25.8±7.8 s-1; p=0.43). Conclusion: Stable patients with cardiac transplantation have increased myocardial T2 values, consistent with resting myocardial oedema or fibrosis. In contrast, USPIO-enhanced MRI is normal and stable over time suggesting the absence of chronic macrophage-driven cellular inflammation. It remains to be determined whether USPIO-enhanced MRI may be able to identify acute cardiac transplant rejection.

• Item Type: Articles
• Additional Information: Funding: This work was supported by the Chief Scientist Office (ETM/266). SA, MRD and DEN are supported by the British Heart Foundation (FS/12/83; FS/14/78/31020; CH/09/002). DEN is the recipient of a Wellcome Trust Senior Investigator Award (WT103782AIA).
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Petrie, Professor Mark
• Authors: Stirrat, C. G., Alam, S., MacGillivray, T. J., Gray, C., Dweck, M. R., Jones, V., Wallace, W., Payne, J. R., Prasad, S. K., Gardner, R. S., Petrie, M. C., Mirsadraee, S., Henriksen, P., Newby, D. E., and Semple, S.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
• Journal Name: Open Heart
• Publisher: BMJ Publishing Group
• ISSN: 2053-3624
• ISSN (Online): 2053-3624
• First Published: First published in Open Heart