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

Abstract

Our aim was to investigate the role of left atrial longitudinal strain (LALS) in the non-invasive diagnosis of acute cellular rejection (ACR) episodes in heart transplant (HTx) recipients. Methods: We performed successive echocardiographic exams in 18 consecutive adult HTx recipients in their first year after HTx within 3 h of the routine surveillance endomyocardial biopsies (EMB) in a single center. LALS parameters were analyzed with two different software. We investigated LALS association with ACR presence, as well as inter-vendor variability in comparable LALS values. Results: A total of 147 pairs of EMB and echo exams were carried out. Lower values of LALS were significantly associated with any grade of ACR presence. Peak atrial longitudinal strain (PALS) offered the best diagnostic value for any grade of ACR, with a C statistic of 0.77 using one software (95% CI 0.68–0.84, p < 0.0005) and 0.64 with the other (95% CI 0.54–0.73, p = 0.013) (p = 0.02 for comparison between both curves). Reproducibility between comparable LALS parameters was poor (intraclass correlation coefficients were 0.60 for PALS, 95% CI 0.42–0.73, p < 0.0005; and 0.42 for PALS rate, 95% CI −0.13–0.68, p < 0.0005). Conclusions: LALS variables might be a sensitive marker of ACR in HTx recipients, principally discriminating between those studies without rejection and those with any grade of ACR. Inter-vendor variability was significant.

Trajectory of Diastolic Function after Heart Transplantation as Assessed by Left Atrial Deformation Analysis

“…Although the association of absolute NT-proBNP levels with acute cellular rejection is weak, temporal changes provide important clinical information [11]. The neurohormone's temporal changes were also associated with temporal changes in the LA reservoir strain, suggesting a pathophysiological link between the two biomarkers and justifying Rodriguez-Diego's findings about reservoir strains' usefulness in detecting rejection episodes [6].…”

“…As a non-Doppler technique, it is also less dependent on anatomical variations and insonation angle. Similarly to LV and RV deformation parameters, LA reservoir strain may have a role in detecting acute cellular rejections after HTX [ 6 , 7 , 8 ]. Zhu et al demonstrated that LA functions by longitudinal strain are significantly different (impaired) compared with controls, irrespective of surgical technique [ 9 ].…”

Diastolic function in heart transplant: From physiology to echocardiographic assessment and prognosis

“…An association between increased ventricular filling pressures and reduced atrial strain has been observed ( 28 ). Furthermore, a recent study hinted at a possible role of LA-PALS in detecting ACR ( 29 ). Rodriguez-Diego et al found a significant decrease in PALS in presence of any degree of ACR, even though significant inter-vendor strain reproducibility was reported ( 29 ).…”

“…Furthermore, a recent study hinted at a possible role of LA-PALS in detecting ACR ( 29 ). Rodriguez-Diego et al found a significant decrease in PALS in presence of any degree of ACR, even though significant inter-vendor strain reproducibility was reported ( 29 ). A possible explanation for this finding might be found in the role of PALS in detecting subtle diastolic changes related to ACR episodes, in which different grades of inflammation affect the myocardium.…”