Strain and strain rate imaging using speckle tracking in acute allograft rejection in children with heart transplantation

Sehgal, Swati; Blake, Jennifer; Sommerfield, Julie; Aggarwal, Sanjeev

doi:10.1111/petr.12415

Cited by 36 publications

(56 citation statements)

References 30 publications

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“…2 In our present study, longitudinal strain and strain rate values of left ventricular lateral wall and of the middle segment of interventricular septum during rejection period were found to be lower than those during periods without rejection. However, statistically significant decreases were observed only in longitudinal strain and strain rate values of midseptum.…”

Section: Discussionmentioning

confidence: 74%

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Untitled

Gürsu

Varan²,

Sade³

et al. 2017

Exp Clin Transplant

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Objectives: Asymptomatic rejection after heart transplant is difficult to detect by noninvasive methods. The present study investigated the efficacy of echocardiographic strain and the strain rate imaging method in detecting rejection after pediatric heart transplant. Materials and Methods: Fourteen pediatric patients with heart transplant were examined both with endomyocardial biopsy and strain imaging. Patients were divided into 2 groups: group 1 included patients with rejection, and group 2 included patients without rejection. Patients underwent endomyocardial biopsy at regular intervals. Regional systolic function was evaluated by longitudinal myocardial peak systolic values of strain and of strain rate. Differences between the 2 groups were assessed with unpaired t test or Mann-Whitney U test. Results: Acute rejection was detected in 7 patients (4 were female patients). Cardiac diagnosis was restrictive cardiomyopathy in 3 patients, dilated cardiomyopathy in 3 patients, and complex congenital heart disease in 1 patient. After heart transplant, 6 patients had rejection once and 1 patient had rejection twice. Evaluation of biopsy samples revealed grade IB rejection in all patients in group 1. Systolic functions of the 6 patients were determined as normal in standard echocardiographic examination. There were no significant differences in deformation and deformation rates between group 1 and 2 except in midseptal region (P < .05). Conclusions: One of the most significant complications in patients with heart transplant is rejection. Our results suggested that myocardial strain imaging may be valuable in defining low-grade rejection. Key words: Biopsy, Cardiac function, Cardiomyopathy, Echocardiography, Pediatric heart transplant IntroductionEndomyocardial biopsy is currently the criterion standard to diagnose subclinical acute rejection in patients with heart transplant; however, research is ongoing to find more sensitive and noninvasive methods to replace biopsy. In the present study, the efficacy of strain and strain rate imaging methods was investigated in detecting subclinical acute rejection in children with heart transplant. In the literature, studies on this topic are scarce. 1,2 Materials and Methods Study populationFourteen pediatric patients who had heart transplant between the years 2010 and 2012 were included in this study. Patients were evaluated by conventional and tissue Doppler echocardiography and endomyocardial biopsy. All patients were also evaluated by the strain imaging method, synchronously with endomyocardial biopsy. Eight of 14 patients were female. Median age of patients was 14 years (range, 12-16 y). The diagnoses were congenital heart disease in 2 patients, dilated cardiomyopathy in 8 patients, and restrictive cardiomyopathy in 4 patients.Patients were divided into 2 groups: group 1 included patients with rejection, and group 2 included patients without rejection. Rejection was detected in 7 patients (4 of them were female). Median age of patients with rejection was 14 years (r...

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Section: Discussionmentioning

confidence: 74%

“…Hazim Alper Gursu, 1 Birgul Varan, 1 Elif Sade, 2 Ilkay Erdogan, 1 dilated cardiomyopathy in 3 patients, and restrictive cardiomyopathy in 3 patients (Table 1). All patients were symptomatic as New York Heart Association class I at time of biopsy.…”

Section: Evaluation Of Acute Rejection By Measuring Strain Andmentioning

confidence: 99%

Untitled

Gürsu

Varan²,

Sade³

et al. 2017

Exp Clin Transplant

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“…The evaluation of rotational strain (torsion) has been related to alterations in exercise response in transplanted patients 15 . Significantly, an alteration of radial, longitudinal and circumferential strain has been observed in patients with episodes of rejection in relation to their baseline values, with recovery after the rejection episode resolves 6 . In our series, patients were asymptomatic at the time of the study and we only observed episodes of mild rejection (1R) in five out of nine patients in biopsy contemporary to echocardiography, with no episodes of moderate (2R) or severe rejection (3R), which also limits the detection of association with echocardiographic alterations.…”

Section: Discussionmentioning

confidence: 94%

“…However, since this is an invasive procedure with infrequent but potentially serious complications, it is necessary to find new noninvasive diagnostic tools in order to identify patients at risk of rejection and perform targeted confirmatory biopsies 4 . Different possible early rejection markers have been studied and the use of echocardiographic parameters of systolic function based on strain have been described [5][6][7] . The evaluation of myocardial strain allows quantifying the deformation of the myocardium in different axes, both in systole and diastole, in relation to time.…”

Section: Introductionmentioning

confidence: 99%

Evaluación ecocardiográfica de pacientes pediátricos post-trasplante cardiaco en Chile: Aplicación inicial de un protocolo funcional con Strain longitudinal global

Trincado

Molina

Urcelay

et al. 2018

Rev. chil. pediatr.

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Keywords:Heart transplantation, children, echocardiography, heart failure Abstract Introduction: The echocardiographic evaluation of patients after heart transplantation is a useful tool. However, it is still necessary to define an optimal follow-up protocol. Objective: To describe the results of the application of a functional echocardiographic protocol in patients being followed after pediatric heart transplantation. Patients and Method: Alls patients being followed at our institution after pediatric heart transplantation underwent an echocardiographic examination with a functional protocol that included global longitudinal strain. Contemporaneous endomyocardial biopsy results and hemodynamic data were recorded. Results: 9 patients were evaluated with our echocardiographic functional protocol. Of these patients, only 1 showed systolic left ventricular dysfunction according to classic parameters. However, almost all patients had an abnormal global longitudinal strain. Right ventricular systolic dysfunction was observed in all patients. No epidodes of moderate to severe rejectiom were recorded. No correlation was observed between these parameters and pulmonary artery pressure. Conclusions: Subclinical biventricular systolic dysfunction was observed in the majority of the patients in this study. No association with rejection episodes or pulmonary hypertension was observed, which may be related to the absence of moderate or severe rejection episodes during the study period, and to the small sample size. Long term follow-up of these patients may better define the clinical relevance of our findings.

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“…At the moment, there is no reliable noninvasive method to detect cardiac transplant rejection (CTR) aside from endomyocardial biopsy that remains as the “gold standard” invasive method for definitive diagnosis [54]. The advent of STE has been proposed as a possible alternative tool to monitor cardiac allograft function and define the best time to perform myocardial biopsies as well as coronary angiography [22].…”

Section: Clinical Applicationsmentioning

confidence: 99%

Strain Imaging Echocardiography: What Imaging Cardiologists Should Know

López‐Candales

Hernández-Suárez

2017

CCR

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Despite recent advances in clinical imaging, echocardiography remains as the most accessi-ble and reliable noninvasive. Since knowledge of left ventricular systolic function remains so critically important in determining prognosis; every effort should be made to prevent subjective estimations. The advent of strain imaging echocardiography now offers a readily available and portable imaging tool that not only offers an objective characterization of myocardial dynamics; but also allows for early detection of subclinical left ventricular dysfunction. This review outlines the basic concepts of strain imaging to better understand the mechanism of myocardial function as well their applicability in the least common cardiac diagnosis among current clinical practice.

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Strain and strain rate imaging using speckle tracking in acute allograft rejection in children with heart transplantation

Cited by 36 publications

References 30 publications

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Untitled

Evaluación ecocardiográfica de pacientes pediátricos post-trasplante cardiaco en Chile: Aplicación inicial de un protocolo funcional con Strain longitudinal global

Strain Imaging Echocardiography: What Imaging Cardiologists Should Know

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