Strain rate imaging would predict sub-clinical acute rejection in heart transplant recipients

Kato, Toako; Oda, Noboru; Hashimura, Kazuhiko; Hashimoto, Shuji; Nakatani, Takeshi; Ueda, Hatsue-Ishibashi; Shishido, Toshiaki; Komamura, Kazuo

doi:10.1016/j.ejcts.2009.11.037

Cited by 69 publications

(52 citation statements)

References 21 publications

(35 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Our findings are in concordance with most of previously published animal 10,11 and human 12,13 data. The heart graft rejection is characterized by immune cell infiltration, edema and myocyte damage, which results in impaired mechanical LV function, and decrease in strain.…”

Section: Discussionsupporting

confidence: 83%

“…Strain has shown to be more sensitive to early LV changes than LV EF in various pathologies 6 , and it has proven superior in prognosis prediction 7,8 . In the field of heart transplantation, the speckle tracking derived strain has been recently applied, normal values for clinically stable heart transplant recipients were established 9 , and an association between impaired strain and acute rejection was demonstrated in both animal 10,11 and human studies [12][13][14] . The aim of our study was to investigate the utility of speckle tracking derived strain analysis in the diagnosis of acute graft rejection in heart transplant recipients with preserved ejection fraction, and in detecting early subclinical phases of acute rejection.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Decrease in longitudinal strain in heart transplant recipients is associated with rejection

Podroužková¹,

Bedáňová²,

Třetina³

et al. 2015

BIOMED PAP

View full text Add to dashboard Cite

Background. Around 20-40% of heart transplant patients experience moderate to severe rejection within the first year after heart transplantation. Endomyocardial biopsy (EMB) is a gold standard for diagnosing heart transplant rejection. There is a need for non-invasive alternatives that allow for early, safe and reliable diagnosis of acute graft rejection prior to the onset of clinical symptoms. Aims. Our aim was to investigate the potential of speckle tracking derived strain analysis in the diagnosis of acute graft rejection. Methods. Patients indicated for EMB consented to a trans-thoracic echocardiography examination (TTE) within 2 hours of the EMB. Of this cohort, those with at least 2 EMBs separated ≥ 1 week, and whose TTE could be analyzed for strain, were included. The relationship between strain and EMB results was evaluated. Results. Of the 43 patients included (mean age 51.33±1.79, 67% male), 23 had findings of rejection identified on at least one EMB and at least one EMB without rejection for comparison. A significant deterioration in the longitudinal strain during rejection compared to non-rejection was found on apical 4-chamber views (-11.51±0.91 vs -13.48±0.96, P=0.025) and apical 2-chamber views (-11.84±0.78 vs -14.43±0.83, P=0.002). In the patients in whom no rejection was identified on either EBM, there was no significant change in longitudinal strain values at two different time points. Conclusion. Worsening of longitudinal strain was associated with acute cellular rejection. Routine TTE-based strain analysis could help in early detection of cardiac rejection and timing of EMB.

show abstract

Section: Discussionsupporting

confidence: 83%

Section: Introductionmentioning

confidence: 99%

Decrease in longitudinal strain in heart transplant recipients is associated with rejection

Podroužková¹,

Bedáňová²,

Třetina³

et al. 2015

BIOMED PAP

View full text Add to dashboard Cite

show abstract

“…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.…”

Section: Discussionsupporting

confidence: 45%

“…Stengel et al (45) showed that Am and mitral annular systolic contraction velocity were higher in patients with higher degrees of rejection. Likewise, Kato et al indicated that neither conventional echocardiographic indices nor Em or the E/Em mitral flow ratio could differentiate patients with and without allograft rejection (41).…”

Section: Discussionmentioning

confidence: 99%

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

Haghighi

Amin

Chitsazan

et al. 2016

Int Cardiovasc Res J

View full text Add to dashboard Cite

A B S T R A C T Background: Endomyocardial Biopsy (EMB) is the gold standard test for diagnosis of acute allograft cardiac rejection.Objectives: The present study aimed to assess the role of echocardiographic parameters in discriminating patients with and without evidence of acute cardiac allograft rejection. Materials and Methods: In the present cross-sectional study, using convenience sampling, 63 EMB specimens were collected from the patients who had undergone biatrial orthotropic cardiac transplantation. The mean age of the recipients and donors was 30.46 ± 9.49 and 24.55 ± 7.64 years, respectively. There were 51(81%) male recipients and 39(62%) male donors. Echocardiographic examination was performed within the 24 hours of EMB. The data were entered into the SPSS statistical software, version 19 and were analyzed by chi-square test, student's t-test, and one-way ANOVA as appropriated. All the data were two-tailed and P < 0.05 was considered to be statistically significant. Results: Among the 63 EMB specimens evaluated in the present study, mild and moderate acute rejections were seen in 19(30%) and 5(8%) cases, respectively. On Doppler examination, the three groups (without rejection, with mild rejection, and with moderate acute rejection) were significantly different only regarding trans-tricuspid E wave (P = 0.040). Pulsed-wave Tissue Doppler Imaging (TDI) also revealed a significant difference between the patients with and without allograft rejection regarding early diastolic tricuspid and mitral annular motion velocities (P = 0.005 and P = 0.02, respectively). Conclusions: It seems that echocardiographic parameters, including TDI, might be adjunct to, rather than substitution for, EMB findings for early diagnosis of acute allograft rejection. BackgroundCardiac transplantation is considered to be a life-saving treatment option for patients with end-stage heart failure. However, rejection occurs in most patients. Cardiac allograft rejection is classified into three major categories, namely hyperacute, acute, and chronic. Hyperacute rejection occurs within minutes to hours after transplantation and ►Implication for health policy/practice/research/medical education:Cardiac transplantation is a life-saving treatment option for patients with end-stage heart failure. Despite advanced immunosuppressive regimes, acute cardiac allograft rejection is still the major cause of morbidity and mortality in the first year post-transplantation. Identification of patients at an earlier stage would prevent progression to more severe disease and ultimately reduces the risk of long-term complications. In the present study, we assessed the clinical applicability of tissue Doppler imaging techniques in the early diagnosis of acute cardiac allograft rejection.

show abstract

“…These characteristics support the advantages of this technology with respect to routine application in the management and surveillance of pediatric heart transplant patients. Strain and strain rate have recently been shown to have a high sensitivity for detecting acute rejection compared with endomyocardial biopsy in adult transplant recipients [12]. Interestingly, transplant recipients had, on the average, a higher fractional shortening than age-and sex-matched control subjects.…”

Section: Discussionmentioning

confidence: 93%

Longitudinal Myocardial Deformation is Selectively Decreased After Pediatric Cardiac Transplantation: A Comparison of Children 1 Year After Transplantation With Normal Subjects Using Velocity Vector Imaging

et al. 2012

View full text Add to dashboard Cite

The transplanted heart experiences numerous hemodynamic changes during and after cardiac transplantation. This study sought to evaluate the left ventricular myocardial mechanics in the pediatric heart transplant population using Velocity Vector Imaging (VVI). This study retrospectively evaluated 28 heart transplant recipients by echocardiography 12 months after transplantation. Echocardiograms from 28 age- and gender-matched subjects were used as a control group. Peak global longitudinal and circumferential left ventricular strain, systolic strain rate, and diastolic strain rate were obtained. Student's t tests were used to assess differences between the two groups (defined as p ≤ 0.05). The peak global left ventricular longitudinal strain was lower in the transplant group (17.21%) than in the control group (22.14%). The transplant and control groups did not differ significantly in terms of their peak global circumferential strain (20.28% vs. 20.79%, respectively). Similar results were observed for longitudinal and circumferential systolic and diastolic strain rates. The transplant patients showed statistically significant reductions in all peak global longitudinal measures compared with those of the control subjects. Circumferential myocardial deformation appears to be preserved in transplant recipients. This could suggest evidence of ischemia given the known myocardial fiber arrangement of longitudinal fibers toward the endocardial surface, which is also more distal in the coronary arterioles.

show abstract

Strain rate imaging would predict sub-clinical acute rejection in heart transplant recipients

Abstract: SR imaging is of potential clinical value for monitoring acute rejection in heart transplant recipients.

Cited by 69 publications

References 21 publications

Decrease in longitudinal strain in heart transplant recipients is associated with rejection

Decrease in longitudinal strain in heart transplant recipients is associated with rejection

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

Longitudinal Myocardial Deformation is Selectively Decreased After Pediatric Cardiac Transplantation: A Comparison of Children 1 Year After Transplantation With Normal Subjects Using Velocity Vector Imaging

Contact Info

Product

Resources

About