Tissue Doppler imaging for rejection surveillance in pediatric heart transplant recipients

Evaluación ecocardiográfica de pacientes pediátricos post-trasplante cardiaco en Chile: Aplicación inicial de un protocolo funcional con Strain longitudinal global

“…There was no clear association between RV dysfunction and the presence of pulmonary hypertension either prior to transplantation or at the moment of the study, but these results are limited by the small sample size. In this population, an alteration of RV systolic function has been described, which is maintained after the firstyear after transplant when evaluated by tissue Doppler imaging 17 . Additionally, adequate RV function has been shown to have good negative predictive value for cardiac allograft vasculopathy 20 .…”

“…In previous studies, the use of tissue Doppler imaging has demonstrated biventricular diastolic dysfunction during the first year after heart transplantation 16 . In addition, longitudinal follow-up of transplanted patients has shown that during episodes of rejection, A' and E' velocity decreases at both the septal and lateral mitral annulus 17 . The LV strain has also been used for the evaluation of diastolic dysfunction, and it has been observed that LV diastolic strain is associated with an increase in pulmonary capillary pressure during catheterization, so it has been suggested as a possible marker of rejection episodes 18,19 .…”

Global left ventricular relaxation: A novel tissue Doppler index of acute rejection in pediatric heart transplantation

“…15 Several pediatric studies have compared echocardiographic parameters, including TDI-derived velocities, in patients with and without OHTx rejection. [3][4][5][6][7] In light of these findings, some centers reported that TDI has become (A) LVRI distribution among the 4 groups of patients. LVRI Z0.8 differentiated Grade 1R to 3R EMB patients and the early post-transplant group from the Grade 0R EMB and control groups.…”

“…6 In the initial phase of acute rejection, these changes may not alter global ventricular systolic function, but myocardial stiffness increases during the inflammatory process and therefore impairs relaxation velocities within the myocardium. 15 Several pediatric studies have compared echocardiographic parameters, including TDI-derived velocities, in patients with and without OHTx rejection.…”

“…2 Studies in adult and pediatric orthotopic heart transplant (OHTx) recipients have shown that myocardial velocities are altered not only at baseline, but also during acute allograft rejection. [3][4][5][6][7] After OHTx, right ventricular endomyocardial biopsy (EMB) plus histologic evaluation of obtained samples constitutes the standard of reference for detection of acute rejection. 8,9 However, EMB procedures have a risk of complications, particularly in the younger pediatric population, among whom rates of cardiac perforation can be as high as 1% to 3%.…”