Heart failure & cardiomyopathies
Approach to optimal assessment of right ventricular remodelling in heart transplant recipients: insights from myocardial work index, T1 mapping, and endomyocardial biopsy
Authors' conclusion
Subclinical adaptive RV remodelling is characterized by preserved RV EF despite longitudinal function abnormalities, except for MWI. While ultrastructural damage is reflected by MWI, ECV, and T1 time, only MWI has the capability to discriminate functional adaptation from transition to subclinical structural damage.
Study context
- Population
- Heart transplant recipients; endomyocardial biopsy as reference standard
- Participants
- 61 complete data sets
- Comparison
- Echocardiographic myocardial work index (MWI) vs cardiac magnetic resonance (CMR) T1 mapping/extracellular volume (ECV) for detecting rejection-related right ventricular (RV) damage
- Outcome
- Detection of rejection-related RV myocardial damage
Methodological detailsEchocardiography, CMR, right heart catheterization and endomyocardial biopsy in each data set
- Echocardiography, CMR, right heart catheterization and endomyocardial biopsy in each data set
Performance
As reported in the abstract
| Test or model | AUC | Sensitivity | Specificity |
|---|---|---|---|
| MWI | 0.812 (95% CI 0.69-0.94, P < 0.0001) | — not stated in the abstract | 77% |
| T1 time | — not stated in the abstract | 84% | — not stated in the abstract |
| ECV | — not stated in the abstract | 84% | — not stated in the abstract |
AUC
MWI0.812 (95% CI 0.69-0.94, P < 0.0001)
T1 time— not stated in the abstract
ECV— not stated in the abstract
Sensitivity
MWI— not stated in the abstract
T1 time84%
ECV84%
Specificity
MWI77%
T1 time— not stated in the abstract
ECV— not stated in the abstract
— not stated in the abstract
Further findings
RV function in recipients without previous rejection
- Ejection fraction (EF) preserved (mean ± SD)
- 52.0 ± 8.7%
- MWI preserved (mean ± SD)
- 403.2 ± 77.2 mmHg%
- Longitudinal function lower than healthy donors
Changes with rejection
- Significantly reduced longitudinal strain (LS) and MWI, longer T1 time, increased ECV, improved after recovery; RV volumes and EF unchanged
Original publication
Approach to optimal assessment of right ventricular remodelling in heart transplant recipients: insights from myocardial work index, T1 mapping, and endomyocardial biopsy. Eur Heart J Cardiovasc Imaging. Published 6 June 2022. doi:10.
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