Noninvasive imaging technique may help kids with heart transplants

The new method is described online in the Journal of Heart and Lung Transplantation.

The invasive imaging test, a coronary angiogram, involves inserting a catheter into a blood vessel and injecting a dye to look for dangerous plaque on the walls of arteries feeding blood to the heart. This plaque build-up indicates coronary artery disease and is a sign that the body may be rejecting the new heart. Since pediatric heart transplant patients are at high risk of developing coronary artery disease, doctors monitor their arteries on a regular basis. But recurring angiograms become problematic.

“Many of these children have undergone so many operations, we have lost access to their big blood vessels,” says Charles E. Canter, MD, professor of pediatrics. “Sometimes it’s impossible to do catheterization procedures on them.”

Based on experience imaging other types of inflammation in arteries, senior author Samuel A. Wickline, MD, professor of medicine, and his colleagues, including Canter and medical student Mohammad H. Madani, a Doris Duke Clinical Research Fellow, examined whether they could assess coronary artery disease in these children using magnetic resonance imaging (MRI). In this case, the MRI was enhanced with a commonly used contrast agent called gadolinium that is injected into the arteries. Gadolinium is not radioactive and makes areas of inflamed arteries and heart muscle show up brighter on an MRI.

“The brighter it is, the more it is associated with coronary artery disease,” Canter says.

The study included 29 heart transplant patients and eight healthy children who served as controls. The transplant patients underwent standard coronary angiograms as part of their normal care. They also had MRIs of the coronary arteries to examine whether the noninvasive method correlated with the degree of coronary artery disease found in the angiograms. The eight children who served as controls only had MRI scans. The researchers assessing the MRI results were blinded to the results of the transplants patients’ angiograms.

While all of the transplant patients’ angiograms showed evidence of plaque build-up, in only six of them was it severe enough for a diagnosis of coronary artery disease.

These six patients had the brightest coronary arteries on the MRI scans, compared to both the transplant patients without coronary disease and the healthy controls. Still, the 23 transplant patients without diagnosed coronary disease had significantly brighter arteries than the healthy participants. Such evidence demonstrates the need to continue monitoring these patients.

Although the brightness of the arteries on MRI correlated well with a diagnosis of coronary artery disease, gadolinium can be toxic to the kidney, Canter points out. This means the technique can’t be used for patients with poor kidney function. Furthermore, clear images with MRI are difficult in very young children because of their high heart rates. In this study, no participant was younger than age 10. Nevertheless, Canter sees a possible future place for this technique in helping to monitor the progress of coronary artery disease in transplant patients.

“The results of this pilot study were very promising,” Canter says. “But we need to look at more patients. We’re in the process of developing a bigger study to confirm and refine the results. I think eventually this could be used as a screening technique, not so much to eliminate, but to reduce the number of angiograms.”

Madani MH, Canter CE, Balzer DT, Watkins MP, Wickline SA. Noninvasive detection of transplant coronary artery disease with contrast-enhanced cardiac MRI in pediatric cardiac transplants. Journal of Heart and Lung Transplantation. Online July 2, 2012.

This work was supported by the Children’s Discovery Institute, St. Louis Children’s Hospital, Washington University School of Medicine in St. Louis and a Doris Duke Clinical Research Fellowship.

Washington University School of Medicine’s 2,100 employed and volunteer faculty physicians also are the medical staff of Barnes-Jewish and St. Louis Children’s hospitals. The School of Medicine is one of the leading medical research, teaching and patient care institutions in the nation, currently ranked sixth in the nation by U.S. News & World Report. Through its affiliations with Barnes-Jewish and St. Louis Children’s hospitals, the School of Medicine is linked to BJC HealthCare.

Media Contact

Julia Evangelou Strait EurekAlert!

More Information:

http://www.wustl.edu

All latest news from the category: Medical Engineering

The development of medical equipment, products and technical procedures is characterized by high research and development costs in a variety of fields related to the study of human medicine.

innovations-report provides informative and stimulating reports and articles on topics ranging from imaging processes, cell and tissue techniques, optical techniques, implants, orthopedic aids, clinical and medical office equipment, dialysis systems and x-ray/radiation monitoring devices to endoscopy, ultrasound, surgical techniques, and dental materials.

Back to home

Comments (0)

Write a comment

Newest articles

Results for control of pollutants in water

Brazilian scientists tested a simple and sustainable method for monitoring and degrading a mixture of polycyclic aromatic hydrocarbons, compounds present in fossil fuels and industrial waste. An article published in the journal Catalysis…

A tandem approach for better solar cells

Perovskite-based solar cells were first proved in 2009 to have excellent light-absorbing properties of methylammonium lead bromide and methylammonium lead iodide, collectively referred to as lead halide perovskites or, more…

The behavior of ant queens is shaped by their social environment

Specialization of ant queens as mere egg-layers is reversible / Queen behavioral specialization is initiated and maintained by the presence of workers. The queens in colonies of social insects, such…

Partners & Sponsors