Noninvasive Diagnosis of Cardiac Allograft Rejection Using Echocardiography Indices of Systolic and Diastolic Function

Bader, Feras; Islam, Nazar Ul; Mehta, Neal; Worthen, Nancy J.; Ishihara, Stephen M.; Stehlik, Josef; Gilbert, E.M.; Litwin, S.

doi:10.1016/j.transproceed.2011.09.039

Cited by 31 publications

(21 citation statements)

References 16 publications

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“…, Bader et al . ). The tricuspid closure opening time (TCO) encompasses the isovolumic contraction time (IVCT), the ejection time (ET) and isovolumic relaxation time (IVRT) (Burghuber ).…”

Section: Methodsmentioning

confidence: 97%

Right ventricle dimensions and function in response to acute hypoxia in healthy human subjects

et al. 2016

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“…, Bader et al . ). The tricuspid closure opening time (TCO) encompasses the isovolumic contraction time (IVCT), the ejection time (ET) and isovolumic relaxation time (IVRT) (Burghuber ).…”

Section: Methodsmentioning

confidence: 97%

Right ventricle dimensions and function in response to acute hypoxia in healthy human subjects

et al. 2016

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“…1,2 The use of LVADs, either as bridge to transplantation or as destination therapy, has resulted in marked improvement of morbidity and mortality in these patients. [3][4][5][6][7][8] Better outcomes observed over the past decade can be attributed to greater experience of LVAD teams in the management of these devices, as well as to the introduction of newer second and third generation continuous-flow LVADs (CF-LVADs), which are smaller, more reliable, and durable.…”

mentioning

confidence: 99%

Pulsatility and the Risk of Nonsurgical Bleeding in Patients Supported With the Continuous-Flow Left Ventricular Assist Device HeartMate II

Wever-Pinzon

Selzman

Drakos

et al. 2013

Circ: Heart Failure

214

111

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Background— Bleeding is an important cause of morbidity and mortality in patients with continuous-flow left ventricular assist devices (LVADs). Reduced pulsatility has been implicated as a contributing cause. The aim of this study was to assess the effects of different degrees of pulsatility on the incidence of nonsurgical bleeding. Methods and Results— The Utah Transplantation Affiliated Hospitals (U.T.A.H.) heart failure and transplant program databases were queried for patients with end-stage heart failure who required support with the continuous-flow LVAD HeartMate II (Thoratec Corp, Pleasanton, CA) between 2004 and 2012. Pulsatility was evaluated by means of the LVAD parameter pulsatility index (PI) and by the echocardiographic assessment of aortic valve opening during the first 3 months of LVAD support. PI was analyzed as a continuous variable and also stratified according to tertiles of all the PI measurements during the study period (low PI: <4.6, intermediate PI: 4.6–5.2, and high PI: >5.2). Major nonsurgical bleeding associated with a decrease in hemoglobin ≥2 g/dL (in the absence of hemolysis) was the primary end point. A total of 134 patients (median age of 60 [interquartile range: 49–68] years, 78% men) were included. Major bleeding occurred in 33 (25%) patients (70% gastrointestinal, 21% epistaxis, 3% genitourinary, and 6% intracranial). In multivariable analysis, PI examined either as a categorical variable, low versus high PI (hazard ratio, 4.06; 95% confidence interval, 1.35–12.21; P =0.04), or as a continuous variable (hazard ratio, 0.60; 95% confidence interval, 0.40–0.92; P =0.02) was associated with an increased risk of bleeding. Conclusions— Reduced pulsatility in patients supported with the continuous-flow LVAD HeartMate II is associated with an increased risk of nonsurgical bleeding, as evaluated by PI.

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“…Bader et al found that in patients with acute antibody-mediated rejection (AMR), LV fractional shortening was significantly reduced compared with those with no AMR (mean ± SD, 31.8 ± 8.9% vs. 36.0 ± 7.1%; p = 0.02). This study concluded, that although one echocardiographic parameter was statistically different in the setting of rejection, lack of consistency and overlap between nonrejection and rejection groups does not permit definitive noninvasive diagnosis of cardiac allograft rejection using this imaging modality [18].…”

Section: Non-doppler Speckle-tracking Derived 2d Strain Imagingmentioning

confidence: 86%

The potential role of ultrasonic strain imaging and immunophenotyping in diagnosing acute rejection after heart transplantation

Daukšas¹,

Sudikienė²,

Malickaitė³

et al. 2012

Seminars in Cardiovascular Medicine

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Background: There has been a continued search for an accurate noninvasive technique for detecting subclinical acute rejection in heart transplant recipients. Ultrasonic deformation imaging-strain/strain rate (SR)-is sensitive in detecting sub-clinical abnormalities in regional myocardial function and could potentially be sensitive tool to detect changes in deformation induced by graft rejection. There is an evidence of the importance of immunophenotyping in determining transplant rejection as well. Aim: to assess the potential role of cardiac ultrasound velocity/strain imaging and immunological testing (alterations in peripheral blood T-cells subsets activation) in the detection of acute allograft rejection proven by endomyocardial biopsy. Patients and methods: A retrospective observational study was carried out involving 28 patients (22 men and 6 women) who underwent a total of 167 routine follow up endomyocardial biopsies with correlative cardiac ultrasound and immunophenotyping data. Myocardial velocity derived from pulsed wave tissue Doppler imaging (PW-TDI) was calculated in the longitudinal direction in basal lateral segment of left ventricle (LV) in 4-chamber view and in the radial direction in basal posterior LV segment in long parasternal axis view. Global systolic strain by speckle tracking was calculated in the longitudinal, radial and circumferential directions. Results: According to the International Society of Heart and Lung Transplantation criteria, 90 biopsies (Group 1) had grade 0, 1R or 2R rejection, and 30 biopsies (Group 2) had grade 3R rejection. The results of the forward selection revealed that the best indicator to predict the rejection was the amount of CD4+/HLA-DR+ cells. Univariate logistic regression analysis showed that global radial systolic strain performs better in terms of receiver-operator-characteristic curves (ROC) than the rest of the measurements (area-under-curve 0.83, where a cutoff value of 32.4% had 91.7% sensitivity and 77.8% specificity). Conclusions: One of the best non-invasive parameters in the detection of acute sub-clinical rejection appears to be the expression of CD4+/HLA-DR+ cells. Among ultrasound markers the best predictor of acute rejection is global radial systolic strain.

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Noninvasive Diagnosis of Cardiac Allograft Rejection Using Echocardiography Indices of Systolic and Diastolic Function

Cited by 31 publications

References 16 publications

Right ventricle dimensions and function in response to acute hypoxia in healthy human subjects

Right ventricle dimensions and function in response to acute hypoxia in healthy human subjects

Pulsatility and the Risk of Nonsurgical Bleeding in Patients Supported With the Continuous-Flow Left Ventricular Assist Device HeartMate II

The potential role of ultrasonic strain imaging and immunophenotyping in diagnosing acute rejection after heart transplantation

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