Changes in circumferential strain can differentiate pediatric heart transplant recipients with and without graft rejection

Abstract

Background Routine surveillance protocols rely heavily on endomyocardial biopsy (EMB) for detection of rejection in pediatric heart transplant recipients. More sensitive echocardiographic tools to assess rejection may help limit the number of EMBs. This study compared changes in left ventricular (LV) strain in patients who had rejection versus those who did not. Methods A single center retrospective review was conducted between 2013 and 2020. Patients were categorized based on rejection history. Echocardiograms were evaluated at the time of 2 consecutive EMBs; in the rejection group, the second echocardiogram was collected at the time of a rejection episode. Conventional measures of LV function and speckle‐tracking echocardiography‐derived longitudinal (LS) and circumferential strain (CS) were measured. Results 17 patients were in the non‐rejection group and 17 were in the rejection group (30 total rejection episodes). The rejection group was older at the time of transplant (12.5 vs. 1.3 years, p = .01). A decline in CS was seen in the rejection group at the second echocardiogram [−18.5 (IQR −21.5, −14.6) to −15.7 (IQR −19.8, −13.2)] while CS improved in the non‐rejection group [−20.8 (IQR −23.9, −17.8) to −23.9 (IQR −24.9, −20.1)]. This difference in change reached significance (p = .02). A similar pattern was seen in LS that neared significance (p = .06). There was no significant difference in ejection fraction change (p = .24). Conclusions Patients in the non‐rejection group displayed improvement in CS between echocardiograms while patients in the rejection group showed subsequent decline. Worsening of LV CS may help identify acute rejection in the early post‐transplant period.

Clinical Predictors of Subacute Myocardial Dysfunction in Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with COVID-19

“…Circumferential strain is a measure that is less commonly used in clinical practice and is a less reproducible measure of myocardial deformation compared to GLS; however, changes in CS may also be an important component of cardiac function assessment in myocardial inflammatory pathologies [ 20 , 24 ] and has been shown to be abnormal in MIS-C [ 11 ]. We found a 16% incidence of abnormal circumferential strain (CS) at follow-up.…”

Multimodality Imaging to Detect Rejection, and Cardiac Allograft Vasculopathy in Pediatric Heart Transplant Recipients—An Illustrative Review

“…Transplantology 2022, 3 245 GLS is sensitive and specific in identifying acute clinical rejection in pediatric HT recipients [6,[26][27][28][29]. Speckle tracking strain and strain rate imaging were also helpful in defining low-grade rejection in children after HT [30].…”

“…Global longitudinal strain (GLS) is the most common strain analysis used in pediatric HT recipients. Several small studies found that noninvasive GLS is sensitive and specific in identifying acute clinical rejection in pediatric HT recipients [6,[26][27][28][29]. Speckle tracking strain and strain rate imaging were also helpful in defining low-grade rejection in children after HT [30].…”