Usefulness of Two-Dimensional Strain Parameters to Diagnose Acute Rejection after Heart Transplantation

Mingo, Susana; Moñivas-Palomero, Vanessa; García‐Lunar, Inés; Mitroi, Cristina; Goirigolzarri‐Artaza, Josebe; Rivero, Betsaida; Oteo, Juan Francisco; Castedo, Evaristo; González-Mirelis, Jesús; Cavero, Miguel Ángel Broc; Gómez‐Bueno, Manuel; Segovia, Javier; Alonso‐Pulpón, Luis

doi:10.1016/j.echo.2015.06.005

Cited by 110 publications

(104 citation statements)

References 22 publications

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“…The intra‐class coefficients for both GLS and GCS were excellent, within or above the range of other published strain studies . The use of the Qlab© semiautomated tracking system as well global strain likely contributed to the rather uniform findings between readers.…”

Section: Discussionsupporting

confidence: 67%

“…The ability of a threshold GCS value to separate rejection from nonrejection was not as distinct as the threshold GLS, with only modest sensitivity and good specificity. The greater utility of GLS and LS over GCS and circumferential strain has been a consistent finding in both the adult and the pediatric HT populations …”

Section: Discussionmentioning

confidence: 68%

“…The greater utility of GLS and LS over GCS and circumferential strain has been a consistent finding in both the adult and the pediatric HT populations. 6,13,23,25 After log 10 transformation an approximate 10-fold change in NT-Pro-BNP was consistent with rejection. The log-transformed BNP had only modest sensitivity and specificity in identifying rejection.…”

Section: The Relationship Between Previous Cav and Rejection Presents Anmentioning

confidence: 82%

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Two‐dimensional systolic speckle tracking echocardiography provides a noninvasive aid in the identification of acute pediatric heart transplant rejection

et al. 2019

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Background Acute rejection is an important cause of morbidity and mortality in the pediatric heart transplant (HT) population. A reliable noninvasive method for diagnosis of clinical rejection could substantially reduce these negative outcomes. Objective Evaluate left ventricular (LV) global longitudinal strain (GLS), and global circumferential strain (GCS) as early noninvasive indicators of acute pediatric HT rejection. Methods An 18‐month prospective cohort study involving 61 patients evaluated absolute change in peak global systolic strain (GLS and GCS) from enrollment (baseline) to next planned clinical encounter (follow‐up) or rejection. Acute rejection defined as a biopsy of grade ≥ 2R or treatment with enhanced immunosuppression by the transplant team, blinded to strain analysis. Two patient cohorts three months post HT without evidence of rejection at enrollment were identified. The study cohort experienced rejection. The control cohort remained free from rejection on follow‐up. Two‐way analysis of variance (ANOVA) models evaluated change in GLS and GCS by cohort group and time. Results Applying exclusion criteria, 51 patients enrolled in the control cohort and 10 in the study cohort. The study cohort's mean GLS declined 33% from baseline to rejection (P < .001) and mean GCS declined 16.6% (P = .021). No significant change from baseline to follow‐up was seen in the control cohort. A threshold absolute GLS value of 16.1% identified acute rejection with 100% sensitivity and 98% specificity (Likelihood Ratio, [LR] 51). Conclusion Noninvasive global longitudinal strain was sensitive and specific in the identification of acute clinical rejection in pediatric HT recipients.

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Section: Discussionsupporting

confidence: 67%

Section: Discussionmentioning

confidence: 68%

Section: The Relationship Between Previous Cav and Rejection Presents Anmentioning

confidence: 82%

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Two‐dimensional systolic speckle tracking echocardiography provides a noninvasive aid in the identification of acute pediatric heart transplant rejection

et al. 2019

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“…76 There has also been an explosion of clinical research and application of two-dimensional strain parameters to diagnose acute rejection after heart transplantation. 85 Furthermore, several studies have attempted to show LV strain may be more feasible and reliable than the traditional measures of LV function, shortening and ejection fraction. 80 Reference ranges of strain values established with meta-analyses and validated with specific image acquisition and data analysis, coupled with forth coming work from the European Association of Cardiovascular Imaging (EACVI) and the American Society Echocardiography (ASE) Industry Task Force to standardize strain imaging and reduce inter-vendor differences and ambiguities in the strain algorithms, will allow deformation imaging to be used more routinely to assess clinical changes in myocardial function “across a broad range of physiologic and pathologic conditions in children.” and provide a valid basis that allows comparison between studies.…”

Section: Discussionmentioning

confidence: 99%

Reference Ranges of Left Ventricular Strain Measures by Two-Dimensional Speckle-Tracking Echocardiography in Children: A Systematic Review and Meta-Analysis

Levy

Machefsky

Sanchez

et al. 2016

Journal of the American Society of Echocardiography

267

215

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Background The establishment of the range of reference values and associated variations of two-dimensional speckle-tracking echocardiography (2DSTE) derived left ventricular (LV) strain is a prerequisite for its routine clinical adoption in pediatrics. The aims were to perform a meta-analysis of normal ranges of LV global longitudinal, circumferential, and radial strain (GLS, GCS, and GRS) measurements derived by 2DSTE in children and identify confounding factors that may contribute to variances in reported measures. Methods A systematic review was launched in Medline, Embase, Scopus, CINAHL, and Cochrane. Search hedges were created to cover the concepts of pediatrics, speckle-tracking echocardiography, and left heart ventricle. Two investigators independently identified and included studies if they reported the 2DSTE derived LV GLS, GCS or GRS. The weighted mean was estimated by using random-effects with 95% confidence interval (CI), heterogeneity was assessed by the Cochran's Q statistic and the inconsistency index (I2) and publication was evaluated using the Egger test. Effects of demographic (age), clinical, and vendor variables were assessed in a meta-regression. Results The search identified 2325 children from 43 data sets. The reported normal mean values of GLS among the studies varied from -16.7% to -23.6% (mean -20.2%, 95% CI -19.5% to -20.8%), GCS varied from -12.9% to -31.4% (mean -22.3%, 95% CI -19.9% to -24.6%) and GRS, varied from 33.9% to 54.5 % (mean 45.2 95% CI 38.3 to 51.7). 26 studies reported LS only from the apical 4-chamber view with a mean of -20.4%, (95% CI -19.8% to -21.7%). 23 studies reported CS (mean, -20.3%, 95% CI -19.4% to -21.2%) and RS (mean, 46.7%, 95% CI 42.3% to 51.1%) from the short axis view at the mid-ventricular level. A significant apex-to-base segmental longitudinal strain (SLS) gradient (P < .01) was observed in the LV free wall. There was significant between- study heterogeneity and inconsistency (I2 > 94% and P < .001 for each strain measure), which was not explained by age, gender, body surface area, blood pressure, heart rate, frame rate, FR/HR ratio tissue-tracking methodology, location of reported strain value along the strain curve, ultrasound equipment, or software. These metaregression showed that these effects were not significant determinants of variations among normal ranges of strain values. There was no evidence of publication bias (P = .40). Conclusions This study defined reference values of 2DSTE derived LV strain in children on the basis of a meta-analysis. In healthy children, the mean LV global longitudinal strain value is -20.2%, (95% CI -19.5% to -20.8%), mean global circumferential strain -22.3%, (95% CI -19.9% to -24.6%), and mean global radial strain is 45.2%, (95% CI 38.3% to 51.7%). LV segmental longitudinal strain has a stable apex-to-base gradient that is preserved throughout maturations. Although variations among different reference ranges in this meta-analysis were not dependent on differences in demographic, clinical, or vendor para...

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“…[13][14][15][16][17][18][27][28][29][30][31] Several studies have shown that strain parameters are abnormally low during an acute rejection episode. [13][14][15][16][17][18][27][28][29][30][31] Several studies have shown that strain parameters are abnormally low during an acute rejection episode.…”

Section: Role Of Ste In the Diagnosis Of Rejection In Oht Patientsmentioning

confidence: 99%

Left ventricular adaptation following orthotopic heart transplantation in children: A speckle tracking echocardiographic imaging study

Sahewalla

Sehgal

Blake

et al. 2019

Clinical Transplantation

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Background: Evolution of left ventricle (LV) function in the pediatric OHT population has not been well described. Our hypothesis was that, in children following OHT without any rejection, there would be progressive normalization of LV size and function over 2 years.Methods: LV function was evaluated using STE and conventional echo parameters at five time points in pediatric OHT patients without any rejection in the first 2 years following OHT and normal controls. LV global peak systolic longitudinal strain (LVPLS) and strain rate, LV peak systolic radial and circumferential strain (LVRS and LVCS), and strain rate were analyzed.

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Usefulness of Two-Dimensional Strain Parameters to Diagnose Acute Rejection after Heart Transplantation

Cited by 110 publications

References 22 publications

Two‐dimensional systolic speckle tracking echocardiography provides a noninvasive aid in the identification of acute pediatric heart transplant rejection

Two‐dimensional systolic speckle tracking echocardiography provides a noninvasive aid in the identification of acute pediatric heart transplant rejection

Reference Ranges of Left Ventricular Strain Measures by Two-Dimensional Speckle-Tracking Echocardiography in Children: A Systematic Review and Meta-Analysis

Left ventricular adaptation following orthotopic heart transplantation in children: A speckle tracking echocardiographic imaging study

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