Abstract 2914: Reduced Myocardial Perfusion Reverse and Systolic Strain Could Detect Sub-clinical Acute Rejection in Heart Transplant Recipients
Background. Invasive screenings for acute rejection by endomyocardial biopsy (EMB) in heart transplant (HTx) recipients are standard procedures. We assessed the use of coronary artery flow reserve (CFR) and strain rate imaging (SRI) obtained by echocardiography as a noninvasive methods for monitoring acute rejection in HTx recipients.
Methods and Results. In 27 transplant recipients, 157 EMBs, 157 CFRs and 108 SRIs were evaluated. The CFRs and SRIs were recorded within 12 hours of EMBs. Angiographically detectable transplant coronary artery diseases and hemodynamic deterioration were not found in any of the patients enrolled. The CFR is reduced when EMB showed greater than grade 2 rejection compared with that when EMB showed less than grade 1b rejection (2.4 ± 0.4 vs. 3.3 ± 0.8 p < 0.001) according to the International Heart and Lung Transplantation criteria. Mean values of peak strain (εsys) obtained from 8 LV segments were smaller when EMB showed greater than grade 2 rejection compared with that when EMB showed less than grade 1b rejection (−23 ± 14.5 vs. −34 ± 7.0 %, p < 0.005). The combination of CFR cut-off value of 2.87 and εsys cut-off value of 28.7% showed a sensitivity of 77.7%, a specificity of 100%, and a predictive accuracy of 80.9% for detecting greater than grade 2 rejection.
Conclusions: The combination of CFR and SRI could be of clinical value in monitoring acute rejection in HTx recipients noninvasively and could improve patients’ management by reducing the frequency and repetition of EMBs performed.