Abstract 14601: Myocardial Deformation: A New Imaging Tool to Diagnose and Discriminate the Degree of Acute Rejection After Heart Transplantation
Acute allograft rejection (AAR) is the major cause of morbidity and mortality in the first year after heart transplantation (HT). If not treated early, episodes of AAR lead to a poor prognosis. Thus, its detection and appropriate treatment at a sub-clinical level is critical. At present right ventricular endomyocardial biopsy (EMB) remains the gold standard in diagnosing AAR.
Objective: To assess the potential role of strain measured by speckle tracking to identify AAR proven by EMB and to differenciate the degree of rejection.
Methods: we include 14 consecutive patients transplanted during the last year in our centre. Ten echocardiograms per patient were done the same day of EMB. We recorded images of the 4 and 2-chamber apical views and short axis views. For the assessment of longitudinal (long S), circunferencial (Circ S) and radial (Rad S) strain curves, we analyzed 16 segments.
Results: we analyzed 3024 segments (5% of them not interpretable). According to the International Society of Heart and Lung Transplantation criteria, 84 biopsies had grade 0R AAR, 17 had IR, and 8 had 2R. A long S cut-off value of -13.2% was associated with sensitivity of 71%, specificity of 70% and negative predictive value of 96.2% to discriminate a degree of rejection that requires treatment (> 1R). We compared > 1R vs ≤ 1R AAR longitudinal deformation parameters with the next results: Long S (-12.2 ± 2.9 vs -15.4 ±3.8, P= 0.02), long SR (-0.97±0.1 vs -1.18±0.4 p= 0.01). Strain results and different cut-off long S values are shown in the tables below.
Conclusions: All modalities of strain were decreased in AAR group. Global longitudinal strain was the best parameter to diagnose AAR and also to discriminate ISHLT rejection grade 2R or higher in heart transplant recipients. Therefore, 2D strain imaging could be of clinical value in monitoring and diagnosing AAR and could improve patient management by reducing the number of biopsies performed.
- © 2011 by American Heart Association, Inc.