Early phosphorus 31 nuclear magnetic resonance bioenergetic changes potentially predict rejection in heterotopic cardiac allografts

C. D. Fraser, V. P. Chacko, W. E. Jacobus, P. Mueller, R. L. Soulen, G. M. Hutchins, B. A. Reitz, W. A. Baumgartner

Research output: Contribution to journalArticlepeer-review

Abstract

The development of a noninvasive screening test for the detection of cardiac allograft rejection would improve the potential for management of heart recipients. To assess the possibility that changes in myocardial high-energy phosphate metabolism precede frank rejection, 17 beagles received cervical cardiac allografts. Recipients underwent serial phosphorus 31 nuclear magnetic resonance spectroscopy, endocardial biopsy (blindly graded, 0 to 8), and left ventricular pressure measurements starting on the day of surgery. The first (<24 hours) spectrum was considered the baseline for all additional studies. The phosphocreatine to inorganic phosphate ratio (PCr/Pi), an index of myocardial bioenergetic supply/demand balance, was determined and expressed as a percentage of baseline of initial and all subsequent spectra. To evaluate the predictive utility of the PCr/Pi ratio, a 50% decrease from baseline was designated as a positive test and was correlated with biopsy-proved rejection (score >3). When PCr/Pi values were compared with the subsequent day's biopsy score, we observed a 91% sensitivity, 90% specificity, and a predictive value of 92%. We conclude that the PCr/Pi ratio is sensitive in predicting heterotopic allograft rejection in its earliest stages. Thus phosphorus 31 nuclear magnetic resonance holds promise for clinical use in the noninvasive diagnosis and monitoring of cardiac rejection.

Original languageEnglish (US)
Pages (from-to)197-204
Number of pages8
JournalJournal of Heart Transplantation
Volume9
Issue number3 I
StatePublished - 1990

ASJC Scopus subject areas

  • Transplantation

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