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

Abstract

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.

Echocardiographic assessment of chamber size and ventricular function during the first year after heart transplantation

“…This finding was not influenced by exclusion of patient with PH or elevated mRAP at 1 month, suggesting that the observed improvement in echocardiographically measured RV function parameters is not dependent on either PH or elevated mRAP. The gradual improvement in RV strain parameters, albeit not the absolute values, is comparable to previous published data (Antonczyk et al, 2018). Initially, patients pre-treated with LVAD showed slightly better RV function parameters and less improvement during follow-up than the rest of the cohort.…”

“…It has been reported that strain values correlate to major adverse cardiac events and that failure to improve LV global longitudinal strain (GLS) at 3 months after OHT comprise a higher risk for hospitalization and death following transplantation (Clemmensen, Eiskjaer, Logstrup, Ilkjaer, & Poulsen, 2017;Clemmensen, Logstrup, Eiskjaer, & Poulsen, 2015;Eleid et al, 2010). Ventricular adaptation in the early time period following OHT is sparsely studied, and reports exploring the natural time course of ventricular contractile recovery show conflicting results (Antonczyk et al, 2018;Lunze et al, 2012;Ran, Zhang, Ma, Dong, & Wu, 2020). Hence, more insight into the timeframe taken until ventricular adaptation reaches a 'steady state' after OHT is warranted to improve the clinical value of TTE in this setting.…”

Disfunção Ventricular Direita e Rejeição em Transplante Cardíaco

“…17 Vale ressaltar que os valores de SLG VE, mesmo no grupo 0R do nosso estudo, excederam as faixas relatadas como normais após TC na literatura. 18,19 Avaliação de parâmetros do VD como potenciais marcadores de rejeição subclínica foi relativamente menos explorada em estudos prévios. Clemmensen et al estudaram um grupo de 36 pacientes de TC, achando que a TAPSE foi reduzida no grupo com rejeição celular.…”

Diagnostic value of myocardial strain using two‐dimensional speckle‐tracking echocardiography in acute cardiac allograft rejection: A systematic review and meta‐analysis

“…In our study, the pooled results showed that RS had no relation to ACAR which are in accordance with most previously published data. Antończyk et al 42 reported that RS remained unchanged during within 12 months after HTX and preserved RS might be responsible for maintaining cardiac function in HTX patients. This finding indicates that early stages of edema or fibrosis involve subendocardial myocardial muscle fibers, which leads to attenuation of longitudinal myocardial function only.…”