Diagnostic Performance of Echocardiography for the Detection of Acute Cardiac Allograft Rejection: A Systematic Review and Meta-Analysis

Lü, Wei; Zheng, Jun; Pan, Xudong; Sun, Li‐Zhong

doi:10.1371/journal.pone.0121228

Cited by 20 publications

(12 citation statements)

References 76 publications

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“…In a typical surveillance population, severe hemodynamic compromise is present in <5% of the patients and echocardiography parameters have limited diagnostic performance. 52 , 53 If our findings are further confirmed, evaluation of mitochondrial function can potentially be used as a surrogate of allograft function in an early stage when no other diagnostic markers reveal abnormal allograft function.…”

Section: Discussionmentioning

confidence: 67%

Rejection-associated Mitochondrial Impairment After Heart Transplantation

Romero

Chang

Tabak

et al. 2020

Transplantation Direct

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Background. Mitochondrial dysfunction is associated with poor allograft prognosis. Mitochondrial-related gene expression (GE) in endomyocardial biopsies (EMBs) could be useful as a nonimmune functional marker of rejection. We hypothesize that acute cardiac allograft rejection is associated with decreased mitochondrial-related GE in EMBs. Methods. We collected 64 routines or clinically indicated EMB from 47 patients after heart transplant. The EMBs were subjected to mRNA sequencing. We conducted weighted gene coexpression network analysis to construct module-derived eigengenes. The modules were assessed by gene ontology enrichment and hub gene analysis. Modules were correlated with the EMBs following the International Society of Heart and Lung Transplantation histology-based criteria and a classification based on GE alone; we also correlated with clinical parameters. Results. The modules enriched with mitochondria-related and immune-response genes showed the strongest correlation to the clinical traits. Compared with the no-rejection samples, rejection samples had a decreased activity of mitochondrial-related genes and an increased activity of immune-response genes. Biologic processes and hub genes in the mitochondria-related modules were primarily involved with energy generation, substrate metabolism, and regulation of oxidative stress. Compared with International Society of Heart and Lung Transplantation criteria, GE-based classification had stronger correlation to the weighted gene coexpression network analysis–derived functional modules. The brain natriuretic peptide level, ImmuKnow, and Allomap scores had negative relationships with the expression of mitochondria-related modules and positive relationships with immune-response modules. Conclusions. During acute cardiac allograft rejection, there was a decreased activity of mitochondrial-related genes, related to an increased activity of immune-response genes, and depressed allograft function manifested by brain natriuretic peptide elevation. This suggests a rejection-associated mitochondrial impairment.

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Section: Discussionmentioning

confidence: 67%

Rejection-associated Mitochondrial Impairment After Heart Transplantation

Romero

Chang

Tabak

et al. 2020

Transplantation Direct

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“…Furthermore, echocardiographic examination is usually used in cases of suspected ACR despite negative histological findings due to sampling errors in part related to the nonhomogeneous nature of rejection [ 7 , 8 ]; it is also used to monitor cardiac function during biopsy-proven ACR episodes [ 9 , 10 ]. In a more recent meta-analysis, no single conventional echo-parameter, including left ventricular ejection fraction (LVEF) or tissue Doppler imaging (TDI)-derived measurements, could be recommended as an alternative to EMB for acute rejection diagnosis [ 11 ]. Monitoring of myocardial deformation with the measurement of LV global longitudinal strain (GLS) is known to be a more sensitive tool for diagnosing early subclinical graft dysfunction, regardless of etiology, and its evaluation may be useful when combined with EMB [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the Graft Mechanical Function Using Speckle-Tracking Echocardiography During the First Year After Orthotropic Heart Transplantation

et al. 2018

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BackgroundRecent advances in ultrasound strain imaging facilitate more precise monitoring of subtle myocardial changes and thus may allow for more appropriate assessment of myocardium after orthotopic heart transplantation (OHT). This study aimed to explore longitudinal left ventricular (LV) and right ventricular (RV) function by speckle-tracking echocardiography (STE) during a 12-month follow-up period in relation to acute cellular rejection (ACR) degree ≥2R and the response to intense immunosuppressive therapy with intravenous steroids.Material/MethodsForty-five adult heart transplant recipients were prospectively assessed at a single center from January 2016 until June 2017. Echocardiography was performed serially at baseline and together with routine biopsies at 2 weeks and 1, 2, 3, 6, 9, and 12 months after OHT. Changes in graft function were evaluated using STE before and during ACR and in the resolving period of ACR.ResultsA total of 220 pairs of biopsy specimens and strain recordings were analyzed. Moderate ACR was seen in 30 biopsies (13.6%). In the serial assessment, longitudinal strain parameters of the LV (global and 4-, 2-, 3-chamber longitudinal strain) and RV (global and free wall longitudinal strain) were decreased at baseline and improved significantly (P<0.001) within 12 months after OHT. The degree of improvement was not influenced by ACR. There were no significant differences in circumferential, radial, or longitudinal strain rate, or mechanical dyssynchrony. Reduced LV and RV longitudinal strain was related to ACR degree 2R and increased significantly (P<0.0005) during 3 days of intravenous methylprednisolone therapy.ConclusionsUsing the STE technique, we have documented an acute improvement in mechanical myocardial function following ACR steroid therapy and a progressive recovery of LV and RV longitudinal function during the first year after OHT.

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“…This is of particular importance because the majority of patients remain asymptomatic during the early phases of rejection or exhibit nonspecific symptoms such as fatigue, malaise, and exertional dyspnea. Timely diagnosis is critical because as immunosuppression modification can help prevent progression of rejection, graft failure, and even sudden cardiac death (36,39).…”

Section: Intermediate Postoperative Complications (1 Month To 1 Year)mentioning

confidence: 99%

Evaluation after Orthotopic Heart Transplant: What the Radiologist Should Know

et al. 2019

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Orthotopic heart transplant (OHT) is the treatment of choice for endstage heart disease. As OHT use continues and postoperative survival increases, multimodality imaging evaluation of the transplanted heart will continue to increase. Although some of the imaging is performed and interpreted by cardiologists, a substantial proportion of images are read by radiologists. Because there is little to no consensus on a systematic approach to patients after OHT, radiologists must become familiar with common normal and abnormal posttreatment imaging features. Intrinsic transplant-related complications may be categorized on the basis of time elapsed since transplant into early (0-30 days), intermediate (1-12 months), and late (>12 months) stages. Although there can be some overlap between stages, it remains helpful to consider the time elapsed since surgery, because some complications are more common at certain stages. Recognition of differing OHT surgical techniques and their respective postoperative imaging features helps to avoid image misinterpretation. Expected early postoperative findings include small pneumothoraces, pleural effusions, pneumomediastinum, pneumopericardium, postoperative atelectasis, and an enlarged cardiac silhouette. Early postoperative complications also can include sternal dehiscence and various postoperative infections. The radiologist's role in the evaluation of allograft failure and rejection, endomyocardial biopsy complications, cardiac allograft vasculopathy, and posttransplant malignancy is highlighted. Because clinical manifestations of disease may be delayed in transplant recipients, radiologists often recognize postoperative complications on the basis of imaging and may be the first to suggest a specific diagnosis and thus positively affect patient outcomes.

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Diagnostic Performance of Echocardiography for the Detection of Acute Cardiac Allograft Rejection: A Systematic Review and Meta-Analysis

Cited by 20 publications

References 76 publications

Rejection-associated Mitochondrial Impairment After Heart Transplantation

Rejection-associated Mitochondrial Impairment After Heart Transplantation

Evaluation of the Graft Mechanical Function Using Speckle-Tracking Echocardiography During the First Year After Orthotropic Heart Transplantation

Evaluation after Orthotopic Heart Transplant: What the Radiologist Should Know

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