Three‐Dimensional Speckle‐Tracking Echocardiographic Monitoring of Acute Rejection in Heart Transplant Recipients

Abstract

ORIGINAL RESEARCHObjectives-This study assessed the use of 3-dimensional (3D) speckle-tracking echocardiography for noninvasive monitoring and diagnosis of acute rejection in heart transplant recipients.Methods-Fifteen heart transplant recipients underwent 32 endomyocardial biopsies; echocardiography was performed within 3 hours before biopsy. Twenty-four biopsies (acute rejection-negative group) showed grade 0 or 1A rejection, and 8 biopsies (acute rejection-positive group) showed grade 1B or higher rejection (based on the International Society for Heart and Lung Transplantation criteria). Two-dimensional, Mmode, pulsed Doppler, and tissue Doppler echocardiography were performed to assess conventional heart structure and function, and 3D full-volume echocardiography was recorded and analyzed.Results-Global peak longitudinal strain was significantly lower in the acute rejectionnegative group compared to the positive group (mean ± SD, -7.38% ± 1.34% versus -10.88% ± 3.81%; P = .017). Differences in left ventricular global peak radial strain (28.79% ± 10.79% versus 24.32% ± 5.24%; P = .272), global peak circumferential strain (-12.16% ± 4.87% versus -12.61% ± 2.38%; P = .806), and ejection fraction (49.42% ± 12.17% versus 50.68% ± 7.26%; P = .824) between the negative and positive groups were not significant. Significant correlations were observed between the left ventricular ejection fraction and global peak longitudinal, global peak radial, and global peak circumferential (r = -0.72; P < .001; r = 0.60; P < 0.001; and r = -0.69; P < 0.001, respectively). Receiver operating characteristic curve analysis showed that a global peak longitudinal strain cutoff value of less than -9.55% could predict grade 1B or higher rejection with sensitivity of 87.50% and specificity of 54.17%.Conclusions-Three-dimensional speckle-tracking echocardiography-derived global peak longitudinal strain is a useful parameter for detecting acute rejection; thus, 3D speckle-tracking echocardiography can monitor dynamic and acute rejection (≥1B) in heart transplant recipients.

Left and right ventricular function detection and myocardial deformation analysis in heart transplant patients with long‐time follow‐ups

“…It is useful for early detection of contractility, even before its onset. The peak systolic value of the longitudinal strain (LS) compared with other strain values determined by speckle tracking is a more sensitive parameter for detecting systolic ventricular dysfunction in HTx patients 4–6 …”

“…The peak systolic value of the longitudinal strain (LS) compared with other strain values determined by speckle tracking is a more sensitive parameter for detecting systolic ventricular dysfunction in HTx patients. [4][5][6] Previous studies revealed that the global LS of LV was significantly lower in transplant recipients than in the control group (CG): patients with a normal ejection fraction (EF) showed no deterioration of LS values 3 years after their initial assessment. 5,6 The RV systolic function was reduced in HTx patients compared with that of the controls.…”

Diagnostic value of myocardial strain using two‐dimensional speckle‐tracking echocardiography in acute cardiac allograft rejection: A systematic review and meta‐analysis

“…GLS not only played an important role in ACAR, but also in cardiac allograft vasculopathy 38‐40 . In addition, Du et al 41 reported the potential of 3D STE in evaluating rejection in HTX patients. Their study showed that GLS value less than −9.55% could predict grade 1B or higher rejection with sensitivity of 87.50% and specificity of 54.17%.…”

A szív MR-vizsgálat szerepe kevert típusú (humorális és celluláris) kardiális allograft rejekció esetén

“…A 2D speckle tracking echokardiográfia alkalmas a szív globális és regionális funkciójának jellemzésére, így az AR kimutatásában is fontos szerepet tölthet be. Néhány nemré-giben megjelent 2D speckle tracking echokardiográfiás vizsgálatában azt találták, hogy a globális longitudiná-lis strain (GLS) akut rejekcióban csökken, illetve GLS értéke normalizálódik az immunszuppresszív terápia során, így alkalmas lehet a terápiás válasz nyomonkö-vetésére (30,31).…”