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Final Program


Program-At-A-Glance

Rapid Fire Session

Session: Rapid Fire Session 5: Non-ischemic Cardiomyopathy (including AI) (Monitor 10)

Multiparamteric mapping for diagnosing cardiac allograft vasculopahty

Saturday, February 7, 2026
10:15 AM - 10:22 AM  
Location: Galapagos / Aruba / Ilhabela (2nd Lower Level)
Background: Parametric cardiovascular magnetic resonance (CMR) mapping can be used to detect acute rejection after heart transplantation.1 Many heart transplant recipients develop cardiac allograft vasculopathy (CAV), which remains a major clinical challenge. It has been shown that CAV can be diagnosed by quantitative stress perfusion CMR,2 however the diagnostic value of multiparametric mapping for detection of CAV remains to be determined. The aim of this study was to evaluate if parametric mapping can be used to differentiate between mild CAV0–1 and more severe CAV2–3 in heart transplant recipients.

Methods: Consecutive heart transplant recipients undergoing CMR and invasive coronary angiography at Karolinska University Hospital, were prospectively enrolled. Exclusion criteria included: severe renal dysfunction (eGFR < 30 ml/min/1.73 m²), contraindications to gadolinium, adenosine, or regadenoson, suspicion of acute rejection, or >1 year between angiogram and CMR. Coronary angiographies were visually classified in accordance with the ISHLT CAV classification system, as CAV0 (healthy), CAV1 (mild), CAV2 (moderate) and CAV3 (severe).3 CMR was performed on a 1.5 T scanner (MAGNETOM Sola, Siemens Healthineers, Forchheim, Germany). Native T1 maps were acquired using ECG-gated modified Look-Locker inversion recovery (MOLLI) research sequence4 (5s(3s)3s), native T2 maps with a T2-prepared sequence (MyoMaps, Siemens Healthineers, Forchheim, Germany), and ECV maps derived from native and post-contrast T1 values calibrated by hematocrit. Mean native T1, native T2, and ECV were measured by delineating endo- and epicardial borders using CMR Segment software (Medviso AB, Lund, Sweden). Global parametric values were compared across CAV groups, and ROC analysis were done using SPSS.

Results: In total 79 patients after transplantation was included (CAV0-1 n=71 (90%), CAV2-3, n=8 (10%)). There were no significant differences between the groups in native T1 (1051±41 vs 1061±31, p = 0.50), native T2 (49±5 vs 54±2, p=0.09) or ECV (27±4 vs 31±5, p=0.07). ROC analysis demonstrated sensitivities ranging from 72.5% to 75% and a specificity of 75% for parametric mapping, using cutoffs of 1074 ms for native T1, 52 ms for native T2, and 28.6% for ECV (Figure 2). These values are lower compared to recently published results, which reported 100% sensitivity and 68% specificity using a myocardial perfusion reserve cutoff of 2.2.2

Conclusion: Multiparametric mapping could detect severe CAV, however with a lower sensitivity compared to previously published values for myocardial perfusion reserve. Given the trend towards higher multiparametric values in the severe CAV group, this study may be underpowered. Future studies should focus on a larger study population of patients with severe CAV.

Left ventricular volumes




















































Findings


Average±std.dv.


Age (years)


54.78±17.6


Weight (kg)


86.0±18.09


Height (cm)


174.1±13.5


BSA (m2)


3.92±0.82


LVEDV (ml)


143.4±34.5


LVEDVi (ml/m2)


38.1±11.8


LVESV (ml)


58.6±19.9


LVESVi (ml/m2)


15.5±5.9


LVSV (ml)


84.9±19.8


LVSVi (ml/m2)


22.6±6.85


LVEF (%)


59.3±6.9

Figure 2. ROC analysis with multiparametric mappings. Diagram with native T1; area under the ROC Curve 0.692, sensitivity 75.0%, specificity 75.0%, PPV 0.93, NPV 0.18, Cutoff 1074 ms. Native T2; Area under the ROC Curve 0.840, sensitivity 75.0%, specificity 75.0%, PPV 1.00, NPV 0.21, Cutoff 52 ms. ECV; Area under the ROC Curve 0.785, sensitivity 72.5%, specificity 75.0%, PPV 0.96, NPV 0.23, Cutoff 28.6%.