BACKGROUND There is a critical need for non-invasive methods to detect coronary allograft vasculopathy and to risk stratify heart transplant recipients. Vasodilator stress testing using cardiovascular magnetic resonance imaging (CMR) is a promising technique for this purpose. We aimed to evaluate the safety and the prognostic value of regadenoson stress CMR in heart transplant recipients. METHODS To evaluate the safety, we assessed adverse effects in a retrospective matched cohort study of consecutive heart transplant recipients who underwent regadenoson stress CMR matched in a 2:1 ratio to age- and gender-matched non-heart transplant patients. To evaluate the prognostic value, we compared the outcomes of patients with abnormal vs. normal regadenoson stress CMRs using a composite endpoint of myocardial infarction, percutaneous intervention, cardiac hospitalization, retransplantation or death. RESULTS For the safety analysis, 234 regadenoson stress CMR studies were included - 78 performed in 57 heart transplant recipients and 156 performed in non-heart transplant patients. Those in heart transplant recipients were performed at a median of 2.74 years after transplantation. Thirty-four (44%) CMR studies were performed in the first two years after heart transplantation. There were no differences in the rates of adverse effects between heart transplant recipients and non-heart transplant patients. To study the prognostic value of regadenoson stress CMRs, 20 heart transplant recipients with abnormal regadenoson stress CMRs were compared to 37 with normal regadenoson stress CMRs. An abnormal regadenoson stress CMR was associated with a significantly higher incidence of the composite endpoint compared with a normal regadenoson stress CMR (3-year cumulative incidence estimates of 32.1% vs. 12.7%, p = 0.034). CONCLUSIONS Regadenoson stress CMR is safe and well tolerated in heart transplant recipients, with no incidence of sinus node dysfunction or high-degree atrioventricular block, including in the first two years after heart transplantation. An abnormal regadenoson stress CMR identifies heart transplant recipients at a higher risk for major adverse cardiovascular events.

中文翻译：

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心脏移植受者中热加腺苷应激心血管磁共振成像的安全性和预后价值。


背景技术迫切需要非侵入性方法来检测冠状动脉同种异体移植血管病变并对心脏移植受者进行风险分层。使用心血管磁共振成像（CMR）进行血管舒张压力测试是用于此目的的一种有前途的技术。我们的目的是评估热加腺苷应激 CMR 对心脏移植受者的安全性和预后价值。方法 为了评估安全性，我们在一项回顾性配对队列研究中评估了不良反应，研究对象为连续接受心脏移植的接受者，这些接受者接受了与年龄和性别匹配的非心脏移植患者以 2:1 的比例进行热加腺苷应激 CMR 匹配。为了评估预后价值，我们使用心肌梗死、经皮介入治疗、心脏住院、再移植或死亡的复合终点比较了异常与正常热加腺苷应激CMR的患者的结果。结果 为了进行安全性分析，纳入了 234 项热加腺苷应激 CMR 研究，其中 78 项在 57 名心脏移植受者中进行，156 项在非心脏移植患者中进行。心脏移植受者的心脏移植手术平均在移植后 2.74 年进行。心脏移植后的头两年进行了 34 项 (44%) CMR 研究。心脏移植受者和非心脏移植患者之间的不良反应发生率没有差异。为了研究热加腺苷应激 CMR 的预后价值，将 20 名热加腺苷应激 CMR 异常的心脏移植受者与 37 名热加腺苷应激 CMR 正常的心脏移植受者进行了比较。 与正常的热加腺苷应激 CMR 相比，异常的热加腺苷应激 CMR 与复合终点发生率显着升高相关（3 年累积发生率估计分别为 32.1% 和 12.7%，p = 0.034）。结论 Regadenoson 应激 CMR 对于心脏移植受者来说是安全的且耐受性良好，没有发生窦房结功能障碍或高度房室传导阻滞，包括在心脏移植后的头两年。异常的热加腺苷应激 CMR 表明心脏移植受者发生主要不良心血管事件的风险较高。