Myocardial deformation and acute cellular rejection after heart transplantation: Impact of inter‐vendor variability in diagnostic effectiveness

Abstract

PurposeOur objective was to investigate the impact of inter‐vendor variability in the ability of myocardial strain analysis to detect acute cellular rejection (ACR) in heart transplant recipients.MethodsWe performed serial echocardiographic examinations in 18 consecutive adult heart transplanted patients, in their first year post‐transplantation, within 3 hours of the routine surveillance endomyocardial biopsies (EMB) in a single center. Myocardial strain was analyzed using two software in two different institutions, and inter‐vendor variability of strain values and its association with ACR (any grade or grade ≥2R) was investigated. The parameter of comparison was the peak value of the average curve of strain during the entire cardiac cycle.ResultsA total of 147 pairs of EMB‐echocardiogram were performed, 65 with no ACR, 63 with ACR grade 1R, and 19 with ACR grade ≥2R. Intra‐class correlation coefficients for left ventricle longitudinal, radial, and circumferential strain were 0.38, 0.39, and 0.77, respectively, and 0.32 for right ventricular longitudinal strain. Neither software found significant association of left ventricular longitudinal strain with rejection. Grade ≥2R ACR was associated with left ventricular circumferential strain measured with the first software and with left ventricular radial strain with the other; and ACR of any grade was only significantly associated with right ventricle longitudinal strain measured with the first software.ConclusionsInter‐vendor reproducibility of strain values was low in this study. Some strain parameters were associated to ACR, although these results were inconsistent between two commercially available software. Specific validation of each software is warranted for this clinical indication.

The Role of Left Atrial Longitudinal Strain in the Diagnosis of Acute Cellular Rejection in Heart Transplant Recipients

“…Regarding echocardiographic analysis, conventional and ventricular strain variables in this series were reported at length by our group in a previous paper [ 29 ].…”

“…This finding underlines the robustness of the technique for this purpose. Differences in feasibility of strain measurement and discriminative ability between them highlight the importance of software and inter-vendor validation when studying specific populations and pathologies, as recently shown by one of our group’s studies [ 29 ].…”

“…Our group reported strain analysis applied to ventricular walls and its variability between two different software [ 29 ] in adult HTx recipients. Our aim in this study was to investigate in the same sample if ACR episodes affect LALS (measured by means 2D speckle-tracking echocardiography), the diagnostic impact of LALS in ACR episodes after HTx, and its robustness when analyzed with two different software.…”

Transplate Cardíaco e a “Câmara Secreta”: Como a Avaliação Ecocardiográfica do Ventrículo Direito pode Revelar a Rejeição Celular Aguda

“…9 Ainda, o software utilizado para análises por Carrion et al 8 baseia-se na análise da deformação endocárdica, enquanto outros softwares disponíveis, e historicamente mais utilizados, analisaram a deformação miocárdica de toda a espessura da parede, incluindo todas as suas camadas, também chamada deformação transmural. 10 Neste estudo os parâmetros ecocardiográficos convencionais de análise da função do VD, assim como a deformação miocárdica do VD, apresentaramse significativamente reduzidos no grupo de pacientes com sinais de RCA em comparação com aqueles sem rejeição significativa.11 Além disso, o grupo com RCA moderada também mostrou alterações sugestivas de pior função diastólica do VE em comparação com o grupo sem rejeição significativa.…”

Prediction of heart transplant rejection from routine pathology slides with self-supervised Deep Learning

“…However, organ rejection by the host immune system remains one of the major complications in these patients [2]. Despite the increasing importance of noninvasive methods in the detection of graft rejection, endomyocardial biopsy remains the gold standard for detecting rejection, especially in the first year after transplantation [3,4]. The pathological assessment of such specimens is reserved for highly specialized pathologists and has massive clinical consequences.…”