Natural history of left ventricular mechanics in transplanted hearts: relationships with clinical variables and genetic expression profiles of allograft rejection.

Mackram Eleid, Giuseppe Caracciolo, Eun Joo Cho, Robert L Scott, D Eric Steidley, Susan Wilansky, Francisco A. Arabia, Bijoy K. Khandheria, Partho P. Sengupta

Research output: Contribution to journalArticle

44 Citations (Scopus)

Abstract

The aim of this study was to explore the temporal evolution of left ventricular (LV) mechanics in relation to clinical variables and genetic expression profiles implicated in cardiac allograft function. Considerable uncertainty exists regarding the range and determinants of variability in LV systolic performance in transplanted hearts (TXH). Fifty-one patients (mean age 53 ± 12 years; 37 men) underwent serial assessment of echocardiograms, cardiac catheterization, gene expression profiles, and endomyocardial biopsy data within 2 weeks and at 3, 6, 12, and 24 months after transplantation. Two-dimensional speckle-tracking data were compared between patients with TXH and 37 controls (including 12 post-coronary artery bypass patients). Post-transplantation mortality and hospitalizations were recorded with a median follow-up period of 944 days. Global longitudinal strain (LS) and radial strain remained attenuated in patients with TXH at all time points (p < 0.001 and p = 0.005), independent of clinical rejection episodes. Failure to improve global LS at 3 months (≥ 1 SD) was associated with higher incidence of death and cardiac events (hazard ratio: 5.92; 95% confidence interval: 1.96 to 17.91; p = 0.049). Multivariate analysis revealed gene expression score as the only independent predictor of global LS (R(2) = 0.53, p = 0.005), with SEMA7A gene expression having the highest correlation with global LS (r = -0.84, p < 0.001). Speckle tracking-derived LV strains are helpful in estimating the burden of LV dysfunction in patients with TXH that evolves independent of biopsy-detected cellular rejection. Failure to improve global LS at 3 months after transplantation is associated with a higher incidence of death and cardiac events. Serial changes in LV mechanics correlate with peripheral blood gene expression profiles and may affect the clinical assessment of long-term prognosis in patients with TXH.

Original languageEnglish (US)
Pages (from-to)989-1000
Number of pages12
JournalJACC. Cardiovascular imaging
Volume3
Issue number10
StatePublished - Oct 2010

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Mechanics
Natural History
Allografts
Transplantation
Transcriptome
Biopsy
Gene Expression
Incidence
Left Ventricular Dysfunction
Cardiac Catheterization
Coronary Artery Bypass
Uncertainty
Hospitalization
Multivariate Analysis
Confidence Intervals
Mortality

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Natural history of left ventricular mechanics in transplanted hearts : relationships with clinical variables and genetic expression profiles of allograft rejection. / Eleid, Mackram; Caracciolo, Giuseppe; Cho, Eun Joo; Scott, Robert L; Steidley, D Eric; Wilansky, Susan; Arabia, Francisco A.; Khandheria, Bijoy K.; Sengupta, Partho P.

In: JACC. Cardiovascular imaging, Vol. 3, No. 10, 10.2010, p. 989-1000.

Research output: Contribution to journalArticle

Eleid, Mackram ; Caracciolo, Giuseppe ; Cho, Eun Joo ; Scott, Robert L ; Steidley, D Eric ; Wilansky, Susan ; Arabia, Francisco A. ; Khandheria, Bijoy K. ; Sengupta, Partho P. / Natural history of left ventricular mechanics in transplanted hearts : relationships with clinical variables and genetic expression profiles of allograft rejection. In: JACC. Cardiovascular imaging. 2010 ; Vol. 3, No. 10. pp. 989-1000.
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abstract = "The aim of this study was to explore the temporal evolution of left ventricular (LV) mechanics in relation to clinical variables and genetic expression profiles implicated in cardiac allograft function. Considerable uncertainty exists regarding the range and determinants of variability in LV systolic performance in transplanted hearts (TXH). Fifty-one patients (mean age 53 ± 12 years; 37 men) underwent serial assessment of echocardiograms, cardiac catheterization, gene expression profiles, and endomyocardial biopsy data within 2 weeks and at 3, 6, 12, and 24 months after transplantation. Two-dimensional speckle-tracking data were compared between patients with TXH and 37 controls (including 12 post-coronary artery bypass patients). Post-transplantation mortality and hospitalizations were recorded with a median follow-up period of 944 days. Global longitudinal strain (LS) and radial strain remained attenuated in patients with TXH at all time points (p < 0.001 and p = 0.005), independent of clinical rejection episodes. Failure to improve global LS at 3 months (≥ 1 SD) was associated with higher incidence of death and cardiac events (hazard ratio: 5.92; 95{\%} confidence interval: 1.96 to 17.91; p = 0.049). Multivariate analysis revealed gene expression score as the only independent predictor of global LS (R(2) = 0.53, p = 0.005), with SEMA7A gene expression having the highest correlation with global LS (r = -0.84, p < 0.001). Speckle tracking-derived LV strains are helpful in estimating the burden of LV dysfunction in patients with TXH that evolves independent of biopsy-detected cellular rejection. Failure to improve global LS at 3 months after transplantation is associated with a higher incidence of death and cardiac events. Serial changes in LV mechanics correlate with peripheral blood gene expression profiles and may affect the clinical assessment of long-term prognosis in patients with TXH.",
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