Usefulness of speckle tracking echocardiography and biomarkers for detecting acute cellular rejection after heart transplantation

Cruz, Cecília Beatriz Bittencourt Viana; Hajjar, Ludhmila Abrahão; Bacal, Fernando; Lofrano-Alves, Marco S.; Lima, Márcio Silva Miguel; Abduch, Maria Cristina Donadio; Vieira, Marcelo Luiz Campos; Chiang, Hsu Po; Salviano, Juliana B. C.; Costa, Isabela Bispo Santos da Silva; Fukushima, Júlia Tizue; Sbano, João; Mathias, Wilson; Tsutsui, Jeane Mike

doi:10.1186/s12947-020-00235-w

Cited by 13 publications

(21 citation statements)

References 44 publications

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“…Our data contrast with earlier work showing decreased LVGLS and RV-FWLS in a population with more than 6 months of HT ( 7 ) or a smaller population with a lower rejection frequency with less than 1 year of HT ( 6 ). However, Tseng et al ( 9 ) observed similar results for LVGLS in a retrospective study that included patients with less than 1 year of HT without considering the period of time between transplant and EMB of less than or more than 6 months.…”

Section: Discussioncontrasting

confidence: 99%

“…A recent study by Mingo-Santos et al ( 6 ) suggested that global LV and RV free wall longitudinal strain (FWLS) could help rule out significant ACR during the first year after HT. Other studies found similar results for GLS ( 7 – 9 ). Combined with biomarkers, Cruz et al ( 7 ) reported that patients with ACR had significantly lower values of LVGLS, RV-FWLS, and LV-Twist and higher levels of troponin I than patients without significant ACR.…”

Section: Introductionsupporting

confidence: 75%

“…Other studies found similar results for GLS ( 7 – 9 ). Combined with biomarkers, Cruz et al ( 7 ) reported that patients with ACR had significantly lower values of LVGLS, RV-FWLS, and LV-Twist and higher levels of troponin I than patients without significant ACR.…”

Section: Introductionsupporting

confidence: 75%

“…Among them, 36 patients were in the NACR group and 31 patients were in the PACR group. Statistical analysis for sample size was performed with power analysis based on mean and standard deviation from a similar study ( 7 ). HT, heart transplant; EMB, endomyocardial biopsy; NACR, negative acute cellular rejection; PACR, positive acute cellular rejection.…”

Section: Methodsmentioning

confidence: 99%

“…The calculated sample size for each group before data collection was based on other studies with HT and GLS analysis ( 7 ). The number obtained for each group was 34 subjects.…”

Section: Methodsmentioning

confidence: 99%

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Acute Cellular Rejection in Heart Transplant Patients: Insights of Global Longitudinal Strain, Myocardial Work, and an Exclusive Group of Chagas Disease

Otto¹,

Martins

Dall'Orto³

et al. 2022

Front. Cardiovasc. Med.

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BackgroundEchocardiographic markers associated with asymptomatic acute cellular rejection (ACR) in patients with orthotopic heart transplant (HT) are still under investigation. The aim of our study was to determine clinical and myocardial strain imaging (MSI) variables evaluated by echocardiography associated with ACR in the first year of HT. A separate analysis was performed to compare variables during the first 6 months of HT, when ACR has a prevalence in 60% of patients. Another analysis evaluated an exclusive population with Chagas disease as the cause of HT.MethodsWe prospectively studied 67 patients with less than 1 year of HT, 36 patients without ACR (41% men, age 49 ± 12 years, 52% Chagas disease as the cause of heart failure), and 31 patients with ACR (59% men, age 55 ± 8 years, 74% Chagas disease as the cause of heart failure). Conventional echocardiographic measurements and MSI by global longitudinal strain (GLS) from the left ventricle (LV) and right ventricle free wall (RV-FWLS) and myocardial work (MW) from the left ventricle were obtained by experienced echocardiologists. Clinical variables, such as the presence of diabetes, hypertension, and immunosuppressant drugs, were compared between groups.ResultsHT patients with ACR were older and used more cyclosporine for immunosuppression. The positive ACR group had an increased relative wall thickness and LV mass index and similar LVGLS and RV-FWLS compared to the negative ACR group. Nevertheless, MW analysis observed increased global work efficiency (GWE) in positive ACR. Multivariate analysis identified older age, cyclosporine use, LV mass index, and GWE as independent predictors for detecting rejection. A separate analysis was performed for patients with less than 6 months of HT. Similar MSI was observed in both groups, with a trend for increased GWE in patients with ACR and significantly increased LV mass index in the ACR group. An exclusive group of Chagas patients as the primary cause of HT was analyzed, and similar MSI results for LVGLS, RV-FWLS, and MW were observed for both ACR and the no rejection groups. Additionally, the survival rates at 2 years were similar between the Chagas disease groups.ConclusionLVGLS and RV-FWLS were similar between patients with or without ACR in the first year after HT. Conversely, GWE, a derivative of LVGLS, and LV mass index were increased in positive ACR and could be markers for rejection. Increased LV mass index was also found in a subgroup analysis of patients less than 6 months after HT; however, MSI was similar regardless of ACR. For chagasic patients, rejection in the first year did not increase mortality at the 2-year follow-up, and MSI parameters were similar between patients with or without ACR. In a multivariate analysis to predict ACR, the independent parameters in this study were older age, cyclosporine use, LV mass index, and GWE.

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Section: Discussioncontrasting

confidence: 99%

Section: Introductionsupporting

confidence: 75%

Section: Introductionsupporting

confidence: 75%

Section: Methodsmentioning

confidence: 99%

“…The calculated sample size for each group before data collection was based on other studies with HT and GLS analysis ( 7 ). The number obtained for each group was 34 subjects.…”

Section: Methodsmentioning

confidence: 99%

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Acute Cellular Rejection in Heart Transplant Patients: Insights of Global Longitudinal Strain, Myocardial Work, and an Exclusive Group of Chagas Disease

Otto¹,

Martins

Dall'Orto³

et al. 2022

Front. Cardiovasc. Med.

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Heart transplantation and anti‐HLA antibodY: myocardial dysfunction and prognosis ‐ HeartLAy study

et al. 2023

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AimsThe presence of anti‐human leucocyte antigen (HLA) antibodies has been implicated in a higher incidence of complications as well as mortality rate in heart transplantation. The aim of the study was to identify through non‐invasive parameters early signs of myocardial dysfunction in the presence of anti‐HLA antibodies but without evidence of antibody‐mediated rejection (AMR) and its possible prognostic impact.Methods and resultsA total of 113 heart‐transplanted patients without acute cellular rejection (ACR) and AMR or cardiac allograft vasculopathy (CAV) were prospectively enrolled and divided into two groups [‘HLA+’ (50 patients) and ‘HLA−’ (63 patients)], based on the presence of anti‐HLA antibodies. Each patient was followed for 2 years after the enrolment, recording episodes of AMR, ACR, CAV, and mortality. Clinical characteristics were similar between the two groups. Among laboratory data, N‐terminal pro‐B‐type natriuretic peptide and high‐sensitivity cardiac troponin values were significantly higher in the presence of anti‐HLA antibodies (P < 0.001 and P = 0.003, respectively). The echocardiographic parameters that showed a statistically significant difference between the two groups were deceleration time of E wave (DecT E, P < 0.001), left ventricular global longitudinal strain (P < 0.001), tricuspid annular plane systolic excursion (P = 0.011), tricuspid S′ wave (P = 0.002), and free wall right ventricular longitudinal strain (fwRVLS, P = 0.027), whereas left atrial strain did not differ significantly (P = 0.408). Univariate analysis showed that anti‐HLA antibodies were associated with the development of CAV at both 1 and 2 year follow‐up [odds ratio (OR) 11.90, 95% confidence interval (CI) 1.43–90.79, P = 0.022 and OR 3.37, 95% CI 1.78–9.67, P = 0.024, respectively]. Bivariate analysis demonstrated that both fwRVLS and DecT E were predictors of CAV development independently from HLA status.ConclusionsThe presence of circulating anti‐HLA antibodies is correlated with a mild cardiac dysfunction, even in the absence of AMR, and CAV development. Interestingly, reduced values of DecT E and fwRVLS were predictors of future development of CAV, independently from anti‐HLA antibody.

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Speckle-tracking echocardiography of left and right ventricle and acute cellular rejection in orthotropic heart transplantation: a systematic review and meta-analysis

Xourgia,

Brignoli,

Linder

et al. 2024

Int J Cardiovasc Imaging

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After a cardiac transplantation, the steering of immunosuppression requires an active search for acute cellular rejection (ACR). Surveillance with endomyocardial biopsy (EMB) is the gold standard. Given the costs and potential complications, there is growing interest in the use of non-invasive screening methods. Thus, we have conducted a systematic review and meta-analysis to evaluate the role of speckle-tracking echocardiography as a screening method for ACR. We searched PubMed (CENTRAL) and gray literature for studies presenting data on speckle tracking echocardiography in heart-transplant patients experiencing acute cellular rejection. The primary outcomes of the meta-analysis were left and right ventricular global longitudinal strain. We used random effects models for all our calculations. We pre-registered our meta-analysis with PROSPERO (CRD42024508654). By incorporating data from over 2000 biopsies included in 18 studies, we found that both left (LVGLS, MD -1.96, 95% CI -2.85 to -1.07, p < 0.0001), and right (RVGLS, MD -2.90, 95% CI -4.03 to -1.76, p < 0.00001) ventricular longitudinal strain were lower among patients without ACR. The change of LVGLS from baseline over time was also greater among patients experiencing ACR (MD -2.43, 95% CI -4.82 to -0.05, p = 0.045). Current data suggest that myocardial strain measured by speckle tracking echocardiography is affected in ACR and could potentially be used for early rejection detection as a rule-out strategy, leading to reduction of routine EMB in heart transplant follow-up.

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Usefulness of speckle tracking echocardiography and biomarkers for detecting acute cellular rejection after heart transplantation

Cited by 13 publications

References 44 publications

Acute Cellular Rejection in Heart Transplant Patients: Insights of Global Longitudinal Strain, Myocardial Work, and an Exclusive Group of Chagas Disease

Acute Cellular Rejection in Heart Transplant Patients: Insights of Global Longitudinal Strain, Myocardial Work, and an Exclusive Group of Chagas Disease

Heart transplantation and anti‐HLA antibodY: myocardial dysfunction and prognosis ‐ HeartLAy study

Speckle-tracking echocardiography of left and right ventricle and acute cellular rejection in orthotropic heart transplantation: a systematic review and meta-analysis

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