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Cardiac MRI in Heart Transplantation: Approaches and Clinical Insights.

Radiographics

February 2025

From the Department of Radiology (S.Q., R.C., J.C.C., M.M., B.D.A., R.A.) and the Division of Cardiology, Department of Medicine (V.A., J.E.W., R.L.W., D.C.L.), Northwestern University Feinberg School of Medicine, 737 N Michigan Ave, Ste 1600, Chicago, IL 60611; Prince Charles Hospital, Chermside, Queensland, Australia (V.A.); and the Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Chicago, Ill (M.M.).

Orthotopic heart transplant (OHT) is a well-established therapy for end-stage heart failure that leads to improved long-term survival rates, with careful allograft surveillance essential for optimizing clinical outcomes after OHT. Unfortunately, complications can arise after OHT that can compromise the success of the OHT. Cardiac MRI is continually evolving, with a range of advanced techniques that can be applied to evaluate allograft structure and function.

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Myocardial extracellular volume fraction (ECV) measured via MRI serves as a quantitative indicator of myocardial fibrosis. However, accurate measurement of ECV using MRI in the presence of AF is challenging. Meanwhile, CT could be a promising alternative tool for measuring ECV regardless of sinus rhythm or AF.

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Background: The immune response to infections may become dysregulated and promote myocardial damage contributing to heart failure (HF). We examined the relationship between infection-related hospitalization (IRH) and HF, HF with preserved ejection fraction, and HF with reduced ejection fraction.

Methods And Results: We studied 14 468 adults aged 45 to 64 years in the ARIC (Atherosclerosis Risk in Communities) Study who were HF free at visit 1 (1987-1989).

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Background And Aims: Cardiotoxicity from immune checkpoint inhibitor (ICI) therapy is a challenge in clinical practice, and the assessment of ICI-related myocarditis (ICI-M) is often complicated by a variable phenotype. Cardiac magnetic resonance imaging (CMR) is used frequently, but evidence is poor. Here, we aim to assess the role of CMR in the assessment of suspected ICI-M in a real-world clinical setting.

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Aims: This retrospective cohort study aimed to investigate the efficacy of dual-chamber left Bundle branch pacing (LBBP) as an alternative therapy for heart failure patients with complete left bundle branch block (CLBBB) and indications for defibrillator with cardiac resynchronization therapy (CRT-D).

Methods: 34 patients met inclusion criteria were enrolled in the study. These criteria included a left ventricular ejection fraction (LVEF) of lower than 35%, a New York Heart Association functional class of II-IV, CLBBB meeting Strauss's criteria, intraventricular dyssynchrony, and confirmed correction of CLBBB during LBBP.

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