Global Longitudinal Strain Assessment of the Left Ventricle by Speckle Tracking Echocardiography Detects Acute Cellular Rejection in Orthotopic Heart Transplant Recipients: A Systematic Review and Meta-Analysis

et al. 2021

Cardiovasc Ultrasound

Background Acute cellular rejection (ACR) is a major complication after heart transplantation. Endomyocardial biopsy (EMB) remains the gold standard for its diagnosis, but it has concerning complications. We evaluated the usefulness of speckle tracking echocardiography (STE) and biomarkers for detecting ACR after heart transplantation. Methods We prospectively studied 60 transplant patients with normal left and right ventricular systolic function who underwent EMB for surveillance 6 months after transplantation. Sixty age- and sex-matched healthy individuals constituted the control group. Conventional echocardiographic parameters, left ventricular global longitudinal, radial and circumferential strain (LV-GLS, LV-GRS and LV-GCS, respectively), left ventricular systolic twist (LV-twist) and right ventricular free wall longitudinal strain (RV-FWLS) were analyzed just before the procedure. We also measured biomarkers at the same moment. Results Among the 60 studied patients, 17 (28%) had severe ACR (grade ≥ 2R), and 43 (72%) had no significant ACR (grade 0 – 1R). The absolute values of LV-GLS, LV-twist and RV-FWLS were lower in transplant patients with ACR degree ≥ 2 R than in those without ACR (12.5% ± 2.9% vs 14.8% ± 2.3%, p=0.002; 13.9° ± 4.8° vs 17.1° ± 3.2°, p=0.048; 16.6% ± 2.9% vs 21.4%± 3.2%, p < 0.001; respectively), while no differences were observed between the LV-GRS or LV-GCS. All of these parameters were lower in the transplant group without ACR than in the nontransplant control group, except for the LV-twist. Cardiac troponin I levels were significantly higher in patients with significant ACR than in patients without significant ACR [0.19 ng/mL (0.09–1.31) vs 0.05 ng/mL (0.01–0.18), p=0.007]. The combination of troponin with LV-GLS, RV-FWLS and LV-Twist had an area under curve for the detection of ACR of 0.80 (0.68–0.92), 0.89 (0.81–0.93) and 0.79 (0.66–0.92), respectively. Conclusion Heart transplant patients have altered left ventricular dynamics compared with control individuals. The combination of troponin with strain parameters had higher accuracy for the detection of ACR than the isolated variables and this association might select patients with a higher risk for ACR who will benefit from an EMB procedure in the first year after heart transplantation.

Section: Discussionsupporting

confidence: 86%

Usefulness of speckle tracking echocardiography and biomarkers for detecting acute cellular rejection after heart transplantation

et al. 2021

Cardiovasc Ultrasound

“…Although myocardial strain imaging has been reported to have potential for the detection of graft dysfunction in the early stage (25,26), its diagnostic value has not been widely recognized yet. Our study showed that the LV-GLS was lower in transplant patients with signi cant ACR compared with patients without signi cant ACR, as reported in a recent meta-analysis by Elkaryoni et al (27). When ACR occurs, myocardial deformation is impaired due to in ammatory cellular in ltration and myocardial edema and can be re ected by myocardial strain parameters.…”

Section: Discussionsupporting

confidence: 85%

Right ventricular free wall longitudinal strain as determined by speckle tracking echocardiography is a noninvasive predictor of acute cellular rejection in adult heart transplantation

et al. 2020

Preprint

Background Acute cellular rejection (ACR) is a major complication after heart transplantation. Endomyocardial biopsy (EMB) remains the gold standard for its diagnosis, but with concerning complications. We evaluated the usefulness of speckle tracking echocardiography (STE) and the biomarkers for detecting ACR after heart transplantation. Methods We prospectively studied 60 transplant patients with normal left and right ventricular systolic function who underwent EMB for surveillance sixth months after transplantation. Sixty age- and sex-matched healthy individuals constituted the control group. Conventional echocardiographic parameters left ventricular global longitudinal, radial and circumferential strain (LV-GLS, LV-GRS and LV-GCS, respectively), left ventricular systolic twist (LV-twist) and right ventricular free wall longitudinal strain (RV-FWLS) were analyzed just before procedure. We also measured biomarkers at the same moment. Results Of 60 patients included, 17 (28%) had severe ACR (grade ≥ 2R) and 43 (72%) had no significant ACR (grade 0–1R). Absolute values of LV-GLS, LV-twist and RV-FWLS were lower in transplant patients with ACR degree ≥ 2 R compared with those without ACR (12.5% ± 2.9 vs 14.8% ± 2.3, p = 0.002 ; 13.9° ± 4.8 vs 17.1° ± 3.2, p = 0.048; 21.4%± 3.2 vs 16.6% ± 2.9, p < 0.001; respectively), while no differences were observed in both LV-GRS or LV-GCS. All these parameters were lower in transplant group without ACR than in non-transplant controls, except for LV-twist. Cardiac troponin I levels were significantly higher in patients with significant ACR than in patients without significant ACR [0.19 (0.09–1.31) vs. 0.05 (0.01–0.18), p = 0.007]. In multivariate analysis, RV-FWLS was the only independent predictor of ACR (odds ratio = 0.57; 95% CI = 0.40–0.81; p = 0.02). RV-FWLS < 18.0% had an accuracy of 85% to predict ACR. Conclusion Heart transplant patients have altered left ventricular dynamics compared with non-transplant individuals. RV-FWLS was the only independent predictor of ACR after heart transplantation and should be considered a valuable noninvasive screening parameter for its detection.

“…Although myocardial strain imaging has been reported to have potential for the detection of graft dysfunction in the early stage, its diagnostic value has not been widely recognized yet (19,20). Similarly, as reported in a recent meta-analysis, our study showed that the LV-GLS was lower in transplant patients with signi cant ACR compared with patients without signi cant ACR (29). This may occur secondary to myocardial deformation, and it may be impaired due to in ammatory cellular in ltration and myocardial edema, and can be re ected by myocardial strain parameters.…”

Section: Discussionsupporting

confidence: 84%

Usefulness of Speckle Tracking Echocardiography and Biomarkers for Detecting Acute Cellular Rejection After Heart Transplantation

et al. 2020

Preprint

Background: Acute cellular rejection (ACR) is a major complication after heart transplantation. Endomyocardial biopsy (EMB) remains the gold standard for its diagnosis, but it has concerning complications. We evaluated the usefulness of speckle tracking echocardiography (STE) and biomarkers for detecting ACR after heart transplantation.Methods: We prospectively studied 60 transplant patients with normal left and right ventricular systolic function who underwent EMB for surveillance six months after transplantation. Sixty age- and sex-matched healthy individuals constituted the control group. Conventional echocardiographic parameters, left ventricular global longitudinal, radial and circumferential strain (LV-GLS, LV-GRS and LV-GCS, respectively), left ventricular systolic twist (LV-twist) and right ventricular free wall longitudinal strain (RV-FWLS) were analyzed just before the procedure. We also measured biomarkers at the same moment. Results: Among the included 60 patients, 17 (28%) had severe ACR (grade ≥ 2R), and 43 (72%) had no significant ACR (grade 0 – 1R). The absolute values of LV-GLS, LV-twist and RV-FWLS were lower in transplant patients with ACR degree ≥ 2 R than in those without ACR (12.5% ± 2.9% vs 14.8% ± 2.3%, p=0.002; 13.9° ± 4.8° vs 17.1° ± 3.2°, p=0.048; 21.4%± 3.2% vs 16.6% ± 2.9%, p<0.001; respectively), while no differences were observed between the LV-GRS or LV-GCS. All of these parameters were lower in the transplant group without ACR than in the nontransplant control group, except for the LV-twist. Cardiac troponin I levels were significantly higher in patients with significant ACR than in patients without significant ACR [0.19 ng/mL (0.09–1.31) vs. 0.05 ng/mL (0.01–0.18), p=0.007]. The combination of troponin with LV-GLS, RV FWLS and LV-Twist had an AUC (area under curve) for the detection of ACR of 0.80 (0.68 – 0.92), 0.89 (0.81 – 0.93) and 0.79 (0.66 – 0.92), respectively. Conclusion: Heart transplant patients have altered left ventricular dynamics compared with control individuals. The combination of troponin with strain parameters had higher accuracy for the detection of ACR than the isolated variables and this association might select patients with a higher risk for ACR who will benefit from an EMB procedure in the first year after heart transplantation.