Purpose: Small vessel coronary artery disease is known to cause fibrosis. However, it is not clear whether myocardial fibrosis detected on MRI is associated with the development of restrictive cardiac physiology post-heart transplant. We assessed our heart transplant patients for this process.

Methods: Between 2010 and 2015, we assessed 585 heart transplant patients at our single center. Of these, 32 underwent cardiac MRI imaging for the detection of fibrosis. We divided these patients into those who had myocardial fibrosis (n=17) vs those who did not (n=15). We assessed for intra-cardiac restrictive physiology defined as the equalization of pressures within the cardiac chamber and low CI <2.0. Coronary angiograms were also assessed.

Results: Those patients who received a cardiac MRI and were found to have fibrosis had a significantly lower freedom from the development of restrictive physiology on hemodynamic monitoring compared to those who did not have MRI findings of fibrosis (35.3% vs 80.0%, p=0.040). Furthermore, patients with restrictive physiology had significantly reduced 2-year freedom from small vessel disease on coronary angiogram (23.5% vs 66.7%, p=0.044). These angiograms did not show significant obstructive coronary disease on epicardial findings.

Conclusion: Cardiac MRI appears to be a reliable diagnostic tool to detect myocardial fibrosis associated with restrictive cardiac physiology from small vessel CAV. These patients may be candidates for re-do heart transplant.

CITATION INFORMATION: Kittleson M., Patel J., Kransdorf E., Dimbil S., Levine R., Geft D., Chang D., Czer L., Kobashigawa J. Cardiac MRI May Help to Determine When to Refer Heart Transplant Patients for Redo Heart Transplant Am J Transplant. 2017;17 (suppl 3).

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