Abstract 725: Value of Speckle Tracking Analysis in Non-invasive Diagnosis of Cardiac Allograft Vasculopathy in Heart Transplant Patients
Cardiac allograft vasculopathy (CAV) is the most frequent complication after heart transplantation. Due to diffuse nature of CAV, with frequent involvement of large- and medium-sized vessels as well as the microvasculature, the diagnosis and monitoring of disease depends mostly on invasive techniques. Two dimensional strain (2DS) offers a technique for quantifying transmural gradient of function across ischemic segments. Our aim was to analyze usefulness of 2DS analysis to identify CAV in segments with normal contraction at rest.
Methods: 93 HTx recipients with normal contractility at rest and without acute rejection (mean age 57±14 years, 83 men, time post-HTx 95±54 months) scheduled for echocardiography evaluation were included in the study. 32 presented CAV in angiography and/or IVUS. Longitudinal global 2D strain (2DS) and strain rate (SR) were measured in 4, 2 and 3 chambers views in an 18 myocardial segment model. Sensitivity (S), specificity (Sp) and area under the ROC curve (AUC) were analyzed for each parameter.
Results: Mean EF was 70±7%, without differences between HTX with and without CAV. HTx recipients with CAV showed significantly lower longitudinal global 2DS (−14.25±3% vs. −16.73±3%, p < 0.0001) and peak SR (−0.95±0.3 s-1 vs. −1.07±0.2 s-1, p = 0.001) than HTx recipients without CAV. 2DS was more sensitive than peak SR to identify CAV but both presented low specificity (table⇓).
Conclusions: Analysis with two dimensional strain is useful to identify CAV in HTx patients. Longitudinal global 2DS is the most sensitive parameter and could be used as non-invasive screening tool in the identification of CAV in HTX patients with normal contractility at rest.