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Speckle-Tracking Echocardiography for Monitoring Acute Rejection in Transplanted Heart.
- Source :
-
Transplantation proceedings [Transplant Proc] 2018 Sep; Vol. 50 (7), pp. 2090-2094. Date of Electronic Publication: 2018 Mar 28. - Publication Year :
- 2018
-
Abstract
- Background: The diagnosis of acute cellular rejection (ACR) is a major objective in the management of heart transplant recipients. The aim of this study was to assess the utility of speckle-tracking derived parameters in identifying patients at risk of graft rejection.<br />Methods: A prospective, single-center study was carried out involving 45 consecutive heart transplant patients who underwent a total of 220 routine endomyocardial biopsies (EMBs) with correlative echocardiographic examination.<br />Results: No significant ACR (grade 0-1R) was seen in 190 biopsies (81.2% of the ACR-free group), and moderate ACR requiring specific treatment (grade 2R) was detected in 30 biopsies (13.6% of the ACR group). Grade 3R was not observed. All longitudinal left ventricular (LV) and right ventricular (RV) strain parameters were greater in the ACR-free group than in patients with ACR, while no differences were observed between radial and circumferential strain parameters. In our analysis, we selected RV free wall longitudinal strain (RV FW) ≤ 16.8% and 4-chamber longitudinal strain (4CH LS) ≤ 13.8%, which related to the presence of ACR requiring treatment. We assigned 1 point for each parameter (minimum 0, maximum 2 points) and derived a new echocardiographic index, the Strain Rejection Score (SRS). Our proposed approach-a combination of the 2 abovementioned indices-for screening patients at risk of ACR ≥ 2R, when expressed by a score 2 points, showed good specificity, strong negative predictive value, and the highest area under the curve.<br />Conclusions: Our study demonstrated that combination of 4CH LS and RV FW as a new echocardiographic index, the Strain Rejection Score, can be useful as a noninvasive assessment of ACR during the first year of follow-up after heart transplant.<br /> (Copyright © 2018 Elsevier Inc. All rights reserved.)
Details
- Language :
- English
- ISSN :
- 1873-2623
- Volume :
- 50
- Issue :
- 7
- Database :
- MEDLINE
- Journal :
- Transplantation proceedings
- Publication Type :
- Academic Journal
- Accession number :
- 30177115
- Full Text :
- https://doi.org/10.1016/j.transproceed.2018.03.112