Use of speckle-tracking echocardiography-derived strain and systolic strain rate measurements to predict rejection in transplant hearts with preserved ejection fraction

Andrew S. Tseng, Umama S. Gorsi, Sergio Barros-Gomes, Fletcher A. Miller, Patricia A. Pellikka, Alfredo L. Clavell, Hector R. Villarraga

Research output: Contribution to journalArticlepeer-review

8 Scopus citations

Abstract

Background: Noninvasive diagnosis of allograft rejection in heart transplant recipients is challenging. The utility of 2-dimensional speckle-tracking echocardiography (2D-STE) to predict severe rejection in heart transplant recipients with preserved left ventricular ejection fraction (LVEF) was evaluated. Methods: Adult heart transplant patients with preserved LVEF (> 55%) and severe rejection by biopsy (Rejection Grade ≥ 2R) or no rejection between 1997 and 2011 at the Mayo Clinic in Rochester, Minnesota were evaluated. Transthoracic echocardiography was performed within 1 month of the biopsy. LV global longitudinal and circumferential strain and strain rates (GLS, GLSR, GCS, and GCSR) were analyzed retrospectively. Results: Of 65 patients included, 25 had severe rejection and 40 were normal transplant controls without rejection. Both groups had more men than women (64 and 75%, respectively). Baseline clinical variables were similar between the groups. Both groups had normal LVEF (64.3% vs 64.5%; P =.87). All non-strain echocardiographic variables were similar between the 2 groups. Strain analysis showed significantly increased early diastolic longitudinal strain rate (P =.02) and decreased GCS (P <.001) and GCSR (P =.02) for the rejection group compared with the control group. The area under the receiver operating characteristic curve for GCS was 0.77. With a GCS cutoff of - 17.60%, the sensitivity and specificity of GCS to detect severe acute rejection were 81.8 and 68.4%, respectively. Conclusions: 2D-STE may be useful in detecting severe transplant rejection in heart transplant patients with normal LVEF.

Original languageEnglish (US)
Article number241
JournalBMC cardiovascular disorders
Volume18
Issue number1
DOIs
StatePublished - Dec 22 2018

Keywords

  • Echocardiography
  • Heart transplant
  • Imaging
  • Rejection
  • Strain

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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