BACKGROUND Myocardial fibrosis is a well-described histopathologic feature in heart transplant recipients. Whether myocardial fibrosis in heart transplant recipients is independently associated with clinical outcomes is unclear. We sought to determine whether myocardial fibrosis on late gadolinium enhancement cardiovascular magnetic resonance imaging in heart transplant recipients was independently associated with all-cause death or major adverse cardiac outcomes in the long-term. METHODS Using a cohort of consecutive heart transplant recipients that had cardiovascular magnetic resonance imaging, we determined the prevalence and the patterns of myocardial fibrosis and analyzed associations between myocardial fibrosis and a composite end point of all-cause death or major adverse cardiac events: retransplantation, nonfatal myocardial infarction, coronary revascularization, and heart failure hospitalization. RESULTS One hundred and fifty-two heart transplant recipients (age, 54±15 years; 29% women; 5.0±5.4 years after heart transplantation) were included. Myocardial fibrosis was present in 18% (37% infarct pattern, 41% noninfarct pattern, and 22% both). Its prevalence was positively associated with cardiac allograft vasculopathy grade. With a median follow-up of 2.6 years, myocardial fibrosis was independently associated with all-cause death or major adverse cardiac events (hazard ratio, 2.88; 95% CI, 1.59-5.23; P<0.001) after adjustment for cardiac allograft vasculopathy, history of rejection, time since transplantation, left ventricular ejection fraction, and indexed right ventricular end-diastolic volume. Every 1% increase in myocardial fibrosis was independently associated with a 6% higher hazard for all-cause death or major adverse cardiac events (hazard ratio, 1.06; 95% CI, 1.03-1.09; P<0.001). The addition of myocardial fibrosis variables to models with cardiac allograft vasculopathy, history of rejection, time since transplantation, left ventricular ejection fraction, and indexed right ventricular end-diastolic volume resulted in significant improvements in model fit, suggesting incremental prognostic value. CONCLUSIONS In heart transplant recipients, myocardial fibrosis is seen on late gadolinium enhancement cardiovascular magnetic resonance imaging in 18%. Both the presence and the extent of myocardial fibrosis are independently associated with the long-term risk of all-cause death or major adverse cardiac events.

中文翻译：

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心脏移植受者的心肌纤维化和预后。

背景技术心肌纤维化是心脏移植受者中众所周知的组织病理学特征。目前尚不清楚心脏移植受者的心肌纤维化是否与临床结果独立相关。我们试图确定长期接受晚期late增强心血管磁共振成像的心脏纤维化是否独立于全因死亡或严重不良心脏结局。方法使用队列进行心脏磁共振成像的连续心脏移植受者队列，我们​​确定了心肌纤维化的患病率和模式，并分析了心肌纤维化与全因死亡或主要不良心脏事件的复合终点之间的关联：重新移植，非致命性心肌梗塞 冠状动脉血运重建和心力衰竭住院。结果共纳入152例心脏移植患者（年龄54±15岁；女性29％；心脏移植后5.0±5.4岁）。心肌纤维化的发生率为18％（37％的梗死模式，41％的非梗死模式和22％的两者都存在）。其患病率与心脏同种异体血管病变程度呈正相关。在对心脏同种异体血管病变进行调整后，心肌纤维化的中位随访时间为2.6年，与全因死亡或主要不良心脏事件（危险比，2.88； 95％CI，1.59-5.23； P <0.001）独立相关，排斥史，移植时间，左心室射血分数和右心室舒张末期容积指数。心肌纤维化每增加1％，全因死亡或严重心脏不良事件的危险就增加6％（危险比，1.06； 95％CI，1.03-1.09； P <0.001）。将心肌纤维化变量添加到具有同种异体移植血管病的模型中，排斥反应的历史，移植后的时间，左心室射血分数和索引的右心室舒张末期容积可显着改善模型拟合，提示增加的预后价值。结论在心脏移植受者中，晚期late增强心血管磁共振成像中发现心肌纤维化的比例为18％。心肌纤维化的存在和程度均与全因死亡或重大不良心脏事件的长期风险相关。