Utility of left ventricular systolic torsion derived from 2-dimensional speckle-tracking echocardiography in monitoring acute cellular rejection in heart transplant recipients

Sato, Takahiro; Kato, Tomoko S.; Kamamura, Kazuo; Hashimoto, Shuji; Shishido, Toshiaki; Mano, Akiko; Oda, Noboru; Takahashi, Ayako; Ishibashi‐Ueda, Hatsue; Nakatani, Takeshi; Asakura, Masanori; Kanzaki, Hideaki; Hashimura, Kazuhiko; Kitakaze, Masafumi

doi:10.1016/j.healun.2010.10.014

Cited by 52 publications

(43 citation statements)

References 32 publications

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“…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: 59%

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

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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.

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Section: Discussionsupporting

confidence: 59%

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

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“…36 In patients treated by cardiac transplantation, LVT is reduced in biopsyproven rejection. 37 In hypertrophic cardiomyopathy, the relative increase in wall thickness produces larger radial differences between the endocardium and the epicardium resulting in augmentation of peak LVT. 38 The writhing area (ie, area of null rotation) 3 is displaced apically in hypertrophic cardiomyopathy because of myofiber disarray.…”

Section: Lvt Mechanics In Specific Cardiac Pathologies Cardiomyopathymentioning

confidence: 99%

Left Ventricular Twist and Torsion

Omar

Vallabhajosyula

Sengupta

2015

Circ: Cardiovascular Imaging

100

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A 52-year-old white man visited his physician because he started experiencing shortness of breath on walking short distances at ground level. He had smoked half a packet of cigarettes daily for 40 years. Physical examination revealed a blood pressure of 147/95 mm Hg. Chest examination and chest x-ray were unremarkable, and ECG showed left atrial abnormality. The patient had normal serum electrolytes, blood sugar, and kidney function tests. A stress echocardiogram was ordered to exclude potential coronary artery disease. His resting echocardiography showed an ejection fraction (EF) of 60%, normal septal and posterior wall thickness, and mild diastolic dysfunction (septal early diastolic mitral annular velocity [e′] of 7 cm/s, early diastolic [E wave] to late diastolic [A wave] transmitral Doppler flow velocity ratio [E/A] of 1.4, E-wave deceleration time of 210 ms, E/e′ ratio of 9, and left atrial volume index of 44 mL/m 2 ; Figure 1A). There were no resting segmental wall motion abnormalities suggestive of ischemia. The patient exercised on a treadmill using Bruce protocol for 4 minutes and 43 s, and achieved 6.6 metabolic equivalent of task and maximum heart rate of 148 bpm (88% of his maximum age predicted heart rate). At peak exercise, the patient developed severe dyspnea and his blood pressure was 213/90 mm Hg. Post exercise echocardiography was acquired within 1 minute of exercise termination and showed EF of 69% and no segmental wall motion abnormalities, with Doppler recordings obtained at recovering heart rate of 125 bpm; showing a septal e′ velocity of 7.3 cm/s, E/A of 1.9, E-wave deceleration time of 110 ms, and E/e′ of 13.7, left atrial volume index of 35 mL/m 2 ( Figure 1B). Ten minutes into the recovery period, the blood pressure returned to basal level (145/80 mm Hg). Compared with resting levels, the increased E/A ratio, shortened E-wave deceleration time and relatively increased E/e′ ratio suggested post exercise worsening of diastolic function with elevation of left ventricular (LV) filling pressures. To investigate the mechanistic basis of diastolic dysfunction in this patient, LV deformation was assessed offline using speckletracking echocardiography (STE). Besides characterizing the longitudinal and circumferential shortening, and radial thickening, the LV rotational deformation, that resembles the wringing of a towel, was also measured (Figures 2 and 3). This wringing deformation, also referred to as LV twist (LVT) and the subsequent recoil that occurs in diastole, referred to as untwist, were abnormal in this patient (Figure 4). At rest, the patient had mild diastolic dysfunction, which was associated with a higher than normal LVT and untwist values, compared with the published age-related normal values, 1,2 and low global longitudinal strain. At peak exercise, there was a significant worsening of the patient's diastolic parameters, which was associated with worsening untwist values and further reduction of global longitudinal strain, whereas LVT remained same in magnitude. The following ...

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“…[11][12][13] Experimental and human-based studies with speckle-tracking echocardiography have found a significant relationship between ACR and radial strain values and also with LV torsion. [14][15][16][17] Our objective was to evaluate which echocardiographic parameters (classical or speckletracking derived) can exclude ACR more accurately by performing a prospective study in OHT patients. The ultimate goal is to achieve a safe reduction in the number of EMBs in the early post-OHT period.…”

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confidence: 99%

Usefulness of Two-Dimensional Strain Parameters to Diagnose Acute Rejection after Heart Transplantation

Mingo¹,

Moñivas-Palomero²,

García‐Lunar³

et al. 2015

Journal of the American Society of Echocardiography

107

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Utility of left ventricular systolic torsion derived from 2-dimensional speckle-tracking echocardiography in monitoring acute cellular rejection in heart transplant recipients

Cited by 52 publications

References 32 publications

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

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

Left Ventricular Twist and Torsion

Usefulness of Two-Dimensional Strain Parameters to Diagnose Acute Rejection after Heart Transplantation

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