Echo rejection score: new echocardiographic approach to diagnosis of heart transplant rejection☆

Abstract

Our proposed method for screening patients at risk of acute cardiac rejection with echo rejection score showed a good sensitivity in detection of graft rejection. However, further study is required to determine if it can be used as an adjunct to the myocardial biopsy.

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

“…Marciniak et al 11 found RV free wall strain to be significantly reduced in those with ACR degree $ 1B, 3 in basal and apical segments. Roshanali et al 13 studied RV basal free wall strain and found a nonsignificant reduction in patients with ACR degree $ 3A. 3 In our study, RV free wall strain < 17% was related to a significant degree of ACR, with sensitivity of 85.7%, specificity of 91.1%, and NPV of 98.8%.…”

“…In three studies assessing DTI-derived deformation parameters, ACR was associated with a significant reduction in peak systolic longitudinal and radial strain. [11][12][13] Marciniak et al 11 found a decrease in longitudinal strain in both the right and left ventricles in grade $ 1B ACR. 3 However, in their cohort, the parameter with the best accuracy was radial strain, with a cutoff value of 30%.…”

“…18,19 In their study, LV longitudinal strain was also an independent predictor of ACR. Roshanali et al 13 found basal, lateral, and septal peak systolic longitudinal strain to be significantly reduced in grade $ 3A ACR. 3 Speckle-tracking has many advantages in comparison with DTI, such as deformation analysis in two dimensions, tissue movement assessment independent of adjacent segments, angle independence, and better spatial resolution.…”

“…DTI-derived deformation parameters have been tested in different studies, with high diversity in their cutoff points and consequently with poor reproducibility. [11][12][13] Experimental and human-based studies with speckle-tracking echocardiography have found a significant relationship between ACR and radial strain values and also with LV torsion. [14][15][16][17] Our objective was to evaluate which echocardiographic parameters (classical or speckletracking derived) can exclude ACR more accurately by performing a prospective study in OHT patients.…”

Evaluation of the Role of Conventional and Tissue Doppler Imaging Echocardiography in Detection of Acute Cardiac Allograft Rejection in Heart Transplant Recipients

“…Three smaller studies have also demonstrated that Em significantly reduced in allograft rejection (23,38,39). On the other hand, other studies on 1500 biopsies in nearly 450 patients reported no association between acute allograft rejection and Em (40)(41)(42)(43)(44)(45)(46). Our study found that both tricuspid and mitral annular early (Em), but not late (Am), diastolic velocities were significantly different in the patients with acute allograft rejection.…”