New virtual biopsy may lead to significant improvements in the care of heart transplant patients

The days of heart transplant survivors undergoing invasive biopsies could be over soon after a new MRI technology proved to be safe and effective; Reducing complications and hospitalization.

Scientists at the Victor Chang Heart Research Institute and St Vincent’s Hospital in Sydney hope that a new virtual biopsy designed to detect any signs of heart rejection will be embraced by clinicians around the world.

Approximately 3,500 people worldwide receive heart transplants each year. Most patients experience some form of organ rejection, and while survival rates are high, a small percentage die in the first year after surgery.

Assistant Professor Andrew Jabbour, of the Victor Chang Heart Institute for Research, said the new development will lead to significant improvements in the care of several thousand heart transplant patients worldwide.

It is essential that we be able to monitor these patients closely and with a high degree of accuracy; Now we have a new tool that can do this without the need for a very invasive procedure.

This new virtual biopsy takes less time, is non-invasive, more cost-effective, uses no radiation or contrast agents, and most importantly, patients like it very much.”

Andrew Jabbour, Associate Professor, Victor Chang Heart Research Institute and Consultant Cardiologist at St Vincent’s Hospital, Sydney

Most doctors around the world currently test for rejection by performing a biopsy that helps determine the level and appropriateness of immunosuppressive therapies needed to treat and prevent further rejection.

This invasive procedure involves placing a tube in the jugular vein to allow surgeons to insert a biopsy instrument into the heart to remove multiple samples of heart tissue.

In addition to feeling uncomfortable, it can also lead to rare but serious complications if the heart is perforated or the valve is damaged. Patients usually undergo biopsies about 12 times in the first year after transplantation.

The new MRI technology has proven to be accurate in detecting rejection and works by analyzing levels of cardiac edema that the team has shown is closely related to heart inflammation.

Main results

  • Forty heart transplant patients from St Vincent’s Hospital, Sydney were selected to receive conventional biopsy or the new MRI technique.
  • The results are published in the journal Rotation He revealed that the new test was just as effective at detecting rejection.
  • Secondary findings of the study revealed that despite similarities in requirements for immunosuppression, kidney function, and mortality rates, there were lower rates of hospitalization and infection for those who underwent MRI versus biopsy. Also, only six percent of patients who had the new MRI technology required a biopsy for illustrative reasons. These secondary results are intended to be reconfirmed in larger, planned multicenter studies.

Fellow author and cardiologist Dr Chris Anthony, who helped carry out the study, said: “This technology is now used frequently at St Vincent’s Hospital in Sydney, and I expect that more clinics around the world will adopt this new technology.”

Next steps

The team at the institute and St Vincent’s is now planning a larger, multi-center trial to expand the application of the findings and integrate pediatric transplant recipients.

They are also developing a new genetic test for use in conjunction with an MRI, which will hopefully detect signs of rejection by identifying genetic signals of donor-specific inflammation in the bloodstream. The new technology will also be adapted to detect carditis in the general population, not just transplant recipients.

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