Feasibility and prognostic value of tissue motion annular displacement in patients with heart transplantation

Abstract

BackgroundTissue motion of mitral annular displacement (TMAD) assessment has proved to be an effective method for several cardiovascular diseases including hypertrophic cardiomyopathy, heart failure, non‐ST‐elevation myocardial infarction, etc. However, there are no studies exploring the feasibility of TMAD in heart transplantation (HT) recipients, and the predictive value of this parameter for adverse outcomes in these patients remains unknown. Consequently, this study aimed to evaluate the feasibility of TMAD in the evaluation of left ventricular (LV) systolic function in clinically well adult HT patients, and further investigate the prognostic value of TMAD.MethodsEchocardiography was performed in 155 adult HT patients and 49 healthy subjects. All the subjects were examined by conventional transthoracic two‐dimensional echocardiography and two‐dimensional speckle tracking echocardiography (2D‐STE) with evaluation of the LV end‐diastolic diameter, LV end‐diastolic volume index, LV end‐systolic volume index, interventricular septal thickness, left atrial diameter, mitral annular plane systolic excursion (MAPSE), LV ejection fraction (LVEF), TMAD and LV global longitudinal strain (LVGLS). The end point was defined as all‐causes mortality or posttransplant related hospitalization during follow up. Cox proportional hazards regression was performed to evaluate the prognostic value of the parameters for predicting poor outcomes in HT patients.ResultsA significant positive correlation was found between the measurements of TMAD and LVGLS (r = .714, p < .001). TMAD obtained by 2D‐STE had good reproducibility. The LVGLS and TMAD were significantly lower in HT group than in control group (both p < .001). In HT patients, compared with event free group, adverse outcome group displayed reduced TMAD and LVGLS, and elevated age (p < .001, < .001, = .017, respectively). Patients with higher TMAD (> 9.1 mm) had comparatively better survival when stratified by cutoff value (log‐rank p < .001). LVGLS and TMAD were independently associated with adverse outcomes in multivariable analysis (both p < .001).ConclusionAssessment of TMAD is effective for evaluating LV longitudinal systolic function and predicting adverse outcomes in clinically well adult HT patients.

TMAD enters the toolbox for evaluating selected heart transplant patients

“…If their conclusions 5 are confirmed in other well-documented HTX studies that impose not so narrow criteria on patient selection, allowing consideration of patients who are not so clinical well, then TMAD may have wide application and added advantages over GLS in that it is less dependent on image quality and it is much quicker to perform.…”

“…7 Age, TMAD and GLS differed significantly when the selected HTX patients were divided in those with and without adverse outcomes. 5 Remarkably, TMAD and GLS were linearly related, but they do not have similar physical dimensions. It would be interesting to learn if a sound concept can explain the association, similarly as described for the (inverse nonlinear) connection between EF and ESVi.…”

“…HTX pts are considered "well," if EF ≥ 50%. 5 Perhaps the question should be reversed by asking: do stable HTX patients without exception have EF ≥ 50%?…”

“…[2][3][4] Global longitudinal strain (GLS) is said to (better) detect subclinical abnormalities in asymptomatic patients. An alternative candidate with prognostic relevance in HTX patients concerns tissue motion of mitral annular displacement (TMAD), as recently advanced in a publication by Ji et al 5 That study will receive special attention in this commentary.…”

“…Similar outcomes about EF are documented in the study by Carlhäll et al 10 As announced, TMAD was introduced as a prognostic candidate in HTX patients. 5 Their data base consisted of 437 HTX patients, and 155 adults were selected for prospective analysis on the basis of a long list of criteria, including EF ≥ 50%. Compared with a matched control group, the patients had higher HR, larger left atrial diameter, lower GLS and lower TMAD, all p < .001.…”