Utility of troponin assays for exclusion of acute cellular rejection after heart transplantation: A systematic review

Fitzsimons, Sarah; Evans, Jonathan David; Parameshwar, Jayan; Pettit, Stephen

doi:10.1016/j.healun.2017.12.008

Cited by 28 publications

(23 citation statements)

References 29 publications

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“…The most frequently used biomarkers in patients with heart transplantation are troponin and B-type natriuretic peptide (BNP). However, there is considerable heterogeneity among studies about the timing of their use and their predictive value for detecting ACR [15,16].Two-dimensional speckle-tracking echocardiography (STE) is an echocardiographic modality for the evaluation of myocardial deformation, enabling the determination of multiple parameters involved in cardiac mechanics, and it has emerged as a promising tool for detecting early subclinical cardiac dysfunction in many different scenarios [17,18]. Previous studies in the heart transplant population demonstrated that, in this setting, the data are not definitive, and further exploration of cardiac mechanics is necessary [19,20].…”

Section: Introductionmentioning

confidence: 99%

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

Cruz

Hajjar

Bacal

et al. 2021

Cardiovasc Ultrasound

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Background Acute cellular rejection (ACR) is a major complication after heart transplantation. Endomyocardial biopsy (EMB) remains the gold standard for its diagnosis, but it has concerning complications. We evaluated the usefulness of speckle tracking echocardiography (STE) and biomarkers for detecting ACR after heart transplantation. Methods We prospectively studied 60 transplant patients with normal left and right ventricular systolic function who underwent EMB for surveillance 6 months after transplantation. Sixty age- and sex-matched healthy individuals constituted the control group. Conventional echocardiographic parameters, left ventricular global longitudinal, radial and circumferential strain (LV-GLS, LV-GRS and LV-GCS, respectively), left ventricular systolic twist (LV-twist) and right ventricular free wall longitudinal strain (RV-FWLS) were analyzed just before the procedure. We also measured biomarkers at the same moment. Results Among the 60 studied patients, 17 (28%) had severe ACR (grade ≥ 2R), and 43 (72%) had no significant ACR (grade 0 – 1R). The absolute values of LV-GLS, LV-twist and RV-FWLS were lower in transplant patients with ACR degree ≥ 2 R than in those without ACR (12.5% ± 2.9% vs 14.8% ± 2.3%, p=0.002; 13.9° ± 4.8° vs 17.1° ± 3.2°, p=0.048; 16.6% ± 2.9% vs 21.4%± 3.2%, p < 0.001; respectively), while no differences were observed between the LV-GRS or LV-GCS. All of these parameters were lower in the transplant group without ACR than in the nontransplant control group, except for the LV-twist. Cardiac troponin I levels were significantly higher in patients with significant ACR than in patients without significant ACR [0.19 ng/mL (0.09–1.31) vs 0.05 ng/mL (0.01–0.18), p=0.007]. The combination of troponin with LV-GLS, RV-FWLS and LV-Twist had an area under curve for the detection of ACR of 0.80 (0.68–0.92), 0.89 (0.81–0.93) and 0.79 (0.66–0.92), respectively. Conclusion Heart transplant patients have altered left ventricular dynamics compared with control individuals. The combination of troponin with strain parameters had higher accuracy for the detection of ACR than the isolated variables and this association might select patients with a higher risk for ACR who will benefit from an EMB procedure in the first year after heart transplantation.

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Section: Introductionmentioning

confidence: 99%

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

Cruz

Hajjar

Bacal

et al. 2021

Cardiovasc Ultrasound

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“…As acute rejection promotes cardiomyocyte necrosis and results in compromised cardiac mechanics, cardiac troponin and BNP have been evaluated as potential diagnostic tools for ACR (39,40). There have been controversial results on these biomarkers in the eld of heart transplantation (41,42). Our study used an ultrasensitive assay for cardiac troponin I that detects 10 to 100 times lower levels than standard assays.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, there has been much effort to develop noninvasive and accurate methods that can reduce the need for EMB, including biomarker detection, imaging techniques and genetic tests (13,14). The most used biomarkers in patients with heart transplantation are troponin and BNP, however there is a considerable heterogeneity among studies about the time dosage and the predict value for detect ACR (15,16).…”

Section: Introductionmentioning

confidence: 99%

Right ventricular free wall longitudinal strain as determined by speckle tracking echocardiography is a noninvasive predictor of acute cellular rejection in adult heart transplantation

Cruz

Hajjar

Bacal

et al. 2020

Preprint

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Background Acute cellular rejection (ACR) is a major complication after heart transplantation. Endomyocardial biopsy (EMB) remains the gold standard for its diagnosis, but with concerning complications. We evaluated the usefulness of speckle tracking echocardiography (STE) and the biomarkers for detecting ACR after heart transplantation. Methods We prospectively studied 60 transplant patients with normal left and right ventricular systolic function who underwent EMB for surveillance sixth months after transplantation. Sixty age- and sex-matched healthy individuals constituted the control group. Conventional echocardiographic parameters left ventricular global longitudinal, radial and circumferential strain (LV-GLS, LV-GRS and LV-GCS, respectively), left ventricular systolic twist (LV-twist) and right ventricular free wall longitudinal strain (RV-FWLS) were analyzed just before procedure. We also measured biomarkers at the same moment. Results Of 60 patients included, 17 (28%) had severe ACR (grade ≥ 2R) and 43 (72%) had no significant ACR (grade 0–1R). Absolute values of LV-GLS, LV-twist and RV-FWLS were lower in transplant patients with ACR degree ≥ 2 R compared with those without ACR (12.5% ± 2.9 vs 14.8% ± 2.3, p = 0.002 ; 13.9° ± 4.8 vs 17.1° ± 3.2, p = 0.048; 21.4%± 3.2 vs 16.6% ± 2.9, p < 0.001; respectively), while no differences were observed in both LV-GRS or LV-GCS. All these parameters were lower in transplant group without ACR than in non-transplant controls, except for LV-twist. Cardiac troponin I levels were significantly higher in patients with significant ACR than in patients without significant ACR [0.19 (0.09–1.31) vs. 0.05 (0.01–0.18), p = 0.007]. In multivariate analysis, RV-FWLS was the only independent predictor of ACR (odds ratio = 0.57; 95% CI = 0.40–0.81; p = 0.02). RV-FWLS < 18.0% had an accuracy of 85% to predict ACR. Conclusion Heart transplant patients have altered left ventricular dynamics compared with non-transplant individuals. RV-FWLS was the only independent predictor of ACR after heart transplantation and should be considered a valuable noninvasive screening parameter for its detection.

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“…Rates of significant ACR vary between 5% and 21% 36. Severe rejection can result in significant cardiac dysfunction, but many milder episodes are diagnosed on surveillance biopsies when patients have no or minimal symptoms and signs.…”

Section: Discussionmentioning

confidence: 99%

Cardiac transplantation: indications, eligibility and current outcomes

Bhagra

Pettit

Parameshwar

2018

Heart

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Utility of troponin assays for exclusion of acute cellular rejection after heart transplantation: A systematic review

Cited by 28 publications

References 29 publications

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

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

Right ventricular free wall longitudinal strain as determined by speckle tracking echocardiography is a noninvasive predictor of acute cellular rejection in adult heart transplantation

Cardiac transplantation: indications, eligibility and current outcomes

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