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 Jr. Miller, Patricia Pellikka, Alfredo L. Clavell, Hector R Vilarraga

Research output: Contribution to journalArticle

4 Citations (Scopus)

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

Fingerprint

Graft Rejection
Stroke Volume
Echocardiography
Transplants
Biopsy
ROC Curve
Allografts
Sensitivity and Specificity
Control Groups
Transplant Recipients

Keywords

  • Echocardiography
  • Heart transplant
  • Imaging
  • Rejection
  • Strain

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

@article{30d6bfbd2b474f84acb25aa8d78be910,
title = "Use of speckle-tracking echocardiography-derived strain and systolic strain rate measurements to predict rejection in transplant hearts with preserved ejection fraction",
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.",
keywords = "Echocardiography, Heart transplant, Imaging, Rejection, Strain",
author = "Tseng, {Andrew S.} and Gorsi, {Umama S.} and Sergio Barros-Gomes and Miller, {Fletcher A Jr.} and Patricia Pellikka and Clavell, {Alfredo L.} and Vilarraga, {Hector R}",
year = "2018",
month = "12",
day = "22",
doi = "10.1186/s12872-018-0980-4",
language = "English (US)",
volume = "18",
journal = "BMC Cardiovascular Disorders",
issn = "1471-2261",
publisher = "BioMed Central",
number = "1",

}

TY - JOUR

T1 - Use of speckle-tracking echocardiography-derived strain and systolic strain rate measurements to predict rejection in transplant hearts with preserved ejection fraction

AU - Tseng, Andrew S.

AU - Gorsi, Umama S.

AU - Barros-Gomes, Sergio

AU - Miller, Fletcher A Jr.

AU - Pellikka, Patricia

AU - Clavell, Alfredo L.

AU - Vilarraga, Hector R

PY - 2018/12/22

Y1 - 2018/12/22

N2 - 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.

AB - 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.

KW - Echocardiography

KW - Heart transplant

KW - Imaging

KW - Rejection

KW - Strain

UR - http://www.scopus.com/inward/record.url?scp=85058923229&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85058923229&partnerID=8YFLogxK

U2 - 10.1186/s12872-018-0980-4

DO - 10.1186/s12872-018-0980-4

M3 - Article

C2 - 30579333

AN - SCOPUS:85058923229

VL - 18

JO - BMC Cardiovascular Disorders

JF - BMC Cardiovascular Disorders

SN - 1471-2261

IS - 1

M1 - 241

ER -