Abstract 9162: Echocardiographic Strain Imaging Allows Differentiation Between Heart Transplant Recipients with and Without Coronary Stenoses
Background: Early detection of patients with cardiac allograft vasculopathy (CAV) is a major goal. However, because diffuse distal coronary narrowing is a major determinant of left ventricular (LV) dysfunction in CAV, regional wall motion alterations are less evident. Echocardiographic (ECHO) strain imaging reveals alterations in myocardial contraction not detectable by conventional ECHO. Thus, we assessed its reliability in distinguishing between patients with and without CAV.
Methods: All consecutive transplanted patients without visible alterations of LV kinetics underwent speckle tracking derived 2D strain analyses at rest, before coronary angiography. LV radial, circumferential and longitudinal strain and strain-rate (Sr) were measured and also dyssynchrony and end-systolic dyssynergy indexes were calculated from strain curves. 2D strain data were tested for relationship to angiographic findings.
Results: Of 187 evaluated patients, 56 had no CAV (group 1), 87 diffuse coronary type-B lesions (group 2) and 44 proximal focal stenoses (group 3). Whereas conventional ECHO showed no predictive value for coronary stenoses, certain strain and Sr parameters and indexes appeared predictive for detection of patients with CAV (Fig 1). Thus, the time to peak longitudinal Sr (TpLSr) and the peak longitudinal Sr/TpLSr index showed up to 93.1% and 94.6% sensitivity and specificity, respectively, for differentiation between group 1 and 2. The ayssynchrony and dyssynergy indexes for longitudinal shortening also allowed differentiation between group 2 and 3 (sensitivity and specificity: up to 86.3%).
Conclusions: 2D strain imaging is reliable for CAV prediction and also helpful for differentiation between patients with and without focal coronary stenoses. Our results recommend 2D strain as a non-invasive tool with the potential to facilitate early detection of stenoses and to enable angiographies to be timed, sparing patients frequent routine angiographies.
- Transplantation/medical aspects
- Coronary heart disease
- Strain rate
- Myocardial contraction
- © 2011 by American Heart Association, Inc.