The Immuknow assay reliably reflects the cellular immune function of HTx patients, thereby supporting the immune monitoring and management of these patients. Serial longitudinal Immuknow monitoring allows immune management of therapy according to the individual patient's immune status.

Background Strain imaging during left atrial (LA) reservoir phase (LASr) is used as a surrogate for LA structural remodeling and fibrosis. Atrial fibrillation (AF) patients with >5% low‐voltage zones (LVZs) obtained by 3D‐electro‐anatomical‐mapping have higher recurrence rate post‐ablation. We investigated the relationship between LA remodeling using two‐dimensional‐speckle‐tracking echocardiography (2D‐STE) and high‐density voltage mapping in AF patients. Methods A prospective study of 42 consecutive patients undergoing AF ablation. 2D‐echo, 2D‐STE, and high‐density contact LA bipolar voltage maps were constructed before ablation. LVZs were determined with different bipolar amplitudes and their ratio per patient's LA area were investigated for correlation with LASr. We compared 2D‐LASr results in patients with LVZs ≥ 5% (LVZs group) versus those with LVZ < 5% (non‐LVZs group). Results Compared with non‐LVZs group (n = 15), LVZs group (n = 27) included significantly older patients, more women, more persistent AF, higher CHA2DS2‐VASc score, higher E/A ratio and higher LA volume index (p < .05). LVZs group had lower %LASr values (12.4 ± 5.9% vs. 21.1 ± 6.3, respectively; p<.001). LVZs% in different amplitudes (<0.1 mV, <0.2 mV, and <0.5 mV) were negatively correlated with %LASr (r = −.63, r = −.68, and r = −.72, respectively; p< .001). Atrial strain thresholds for LVZs ≥ 5% in amplitudes <0.1 mV, <0.2 mV, and <0.5 mV were associated with %LASr 12.98, 16.16 and 19.55, respectively; p< .05). In a multivariate analysis, %LASr was the only independent indicator of LVZs (OR, 0.8; 95% CI, 0.6–0.9; p= .04). Conclusions LVZs ≥ 5% has a negative association with atrial %LASr. Thus, a simple 2D‐STE measurement of %LASr can be used as a noninvasive method to evaluate significant LA remodeling and fibrosis in AF patients.

Atrial cardiomyopathy represents a process of structural and functional changes affecting the atria and leading eventually to clinical manifestation of atrial fibrillation and risk of stroke. Multimodality imaging provides a comprehensive evaluation of atrial remodeling and plays a crucial role in the decision-making process in treatment strategy. This paper summarizes the current state of knowledge on the topic of left atrial strain imaging using two-dimensional speckle tracking echocardiography (2D-STE). We focus on our recently published data on left atrial remodeling assessed by 2D-STE versus high-density voltage mapping in patients with atrial fibrillation (AF).